What they didn’t teach in medical school Part 1: Behaviour Change

This is the start of an occasional series about stuff they didn’t teach me in medical school – and I suspect they still don’t teach this stuff. Where it was taught I suspect it was pretty poorly. These musings have come about because most of what I do now, that doesn’t fall into the categories of diagnosing or treating, wasn’t taught in medical school or as part of my specialist training. Some of these things include how to be an administrator, how to run a meeting, how to run a business, how to teach trainees and a whole bunch of stuff around fine-tuning the practice of medicine. I won’t necessarily have the answers about what to do to address these problems but recognition is the first step.

To kick it off with I’m nominating how to change patient behaviour.

Most of what I do on a day to day basis as an oncologist is prescribing medications to treat cancers. But there are a whole lot of behaviours that might also need to be changed or created to help my patients get through their illness. In the same way primary care practitioners need to be able to help their patients change behaviours in order to achieve preventative medicine goals.

Examples of behaviours and problems that might need to be addressed through behaviour change include tobacco, alcohol and substance abuse, obesity and poor fitness, poor adherence to medications or aberrant mechanisms for coping with illness.

I recall being taught how to detect these problems but not a great deal about how to address them. I suspect most busy doctors see their patients and go through the motions of discussing smoking cessation or some other behaviour change but either give up in despair or through lack of time or perhaps take the easy option and write a script for a patch or some other aid (which might help but should be part of a package deal not a one stop solution).

So every doctor dealing with these problems ought to read up or take a class on behaviour change. It’s all the rage in popular non-fiction right now with books on behavioural economics (Nudge by Thaler & Sunstein, Thinking Fast and Slow by Kahneman) and habit change (The Power of Habit by Duhigg) being in the best-seller lists.

If you’re a doctor reading this then one way to learn about it is to try and change one of your own habits. Here a some clues how Charles Duhigg Habit Change Resources

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