Dear Rachel,

Welcome to the New Year 2017. I wanted to take this moment to share a brief article with you on the topic of Patient Engagement.  I also want to invite you to join us for this month's Medical Coaching Learning Community session where I'll be speaking on the topic described below.

Ten Ways to Effectively Engage with the Health Challenged Patient to Optimise Adherence

Written by Rachel Dungan MPSI (adapted from an original article written by Dr Michael Arloski www.realbalance.com) 

When we encounter the  person who is reluctant to adopt all the well intentioned medication and lifestyle prescriptions they have been prescribed, we  need to respond to them  in a 100%  patient-centred way. In each step consider that their readiness for change will be determined in part by their stage of grief and where they fall in Maslow's hierarchy of needs. How quickly they move through the change process will be. in part. determined by past experiences and in part by the support they have in the present to change.  You are a part of that present support.

1)      Meet them with compassion not judgement. Catch yourself quickly before you criticise their lack of adherence to the medication and lifestyle prescription they have been prescribed.  Bite your tongue, and instead of TELLING them what they SHOULD be doing, and warning them, once again, of the dire consequences of non-adherence, respond with EMPATHY and LISTEN.

2)  Seek first to understand their perspective.  ASK them what it was like when they found out about their health challenge or experienced a health event. Don't jump to solutions  or start problem solving.  Really listen. Reflect their feelings. Acknowledge what was real for them. Explore it with them and identify any fears that need to be talked about here.

 3) Don't push.  Be patient and explore more.  While it may feel like this person needs to take swift action with tremendous urgency, be patient. Readiness for change grows at a different rate for each step of the journey.

4) Be their ally. Help them feel that they are not facing this alone. This helps meet their needs for safety and belonging.  Does the patient understand their health challenge? To what degree does the patient understand and buy into the medication and lifestyle changes suggested?  Do they believe the treatment will positively impact their health?

5) Address survival   first. Make sure they are getting the medical help they need.  Explore their fears about health, treatment side-effects, job, business, family and how it all will be impacted by their health challenge.  Help them gain a sense of control and feel more safe and secure in all ways.  Help them to see that they are not completely helpless and vulnerable, but that there are ways they can affect their situation.

 6) Help them process the loss. Talking through the grief is very powerful. Don’t be afraid to be with your patient as they process their feelings and give a voice to the part of them that is afraid. Accept their initial tendency to minimise but slowly help them feel safe enough to move through the other stages of grief.

7) Help them form a plan.  Even if it is very basic, help them develop a plan to face their health challenge and create a “new normal”.  What do they need to know? What skills do they need?  What resources and support do they need?  How could they access these?  Having a plan will give them both hope and a sense of purpose and direction, a map to find their way out of their current situation. It is something to hold on to.

8) Encourage connection. If the basic survival needs feel met the person can reach out to others and will benefit from a sense of belonging. This may include patient support groups, family, friends, co-workers, members of their healthcare team etc.

9) Build self‐esteem. Recognise, acknowledge and  re-inforce all progress. There is no failure, only feedback.  Encourage them to articulate positive learnings from their experiences, both positive and negative.  Help them to grow greater self‐efficacy because as THEY take charge of their health and their life, their self-esteem grows.

10) Nothing succeeds like success. Help the health-challenged person to take small steps to prepare for change and then experiment with actions when they are ready. Build on these easier successes and leave the tougher challenges for later after confidence has been built. Maslow reminds us that "growth forward  customarily takes place in little steps, and each step  forward is made  possible by the feeling of being safe, of operating out into the unknown from a safe home port, of daring because retreat is possible." .How better to set sail towards the unknown lands of change than with a pharmacist on your team as advocate and ally?

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