How to Help Your Patients Make Positive Changes Using The Four Tendencies Framework
As physicians, we do a lot of different things for a lot of different people including, hopefully, ourselves. Sometimes we are more successful than other times.. In her book, Gretchen Rubin explores how we handle expectations-internal and external, and I found it a very useful read.
If I’d known way back when about The Four Tendencies, I’d have been more likely to get my patient charts done before the end of the day. And I’d probably have been more successful at helping my patients change their health habits.
Ms. Rubin states that people fall into four different categories, or Tendencies:
Upholders respond readily to both outer expectations and inner expectations
Questioners question all expectations; they meet an expectation only if they believe it’s justified, so in effect they respond only to inner expectations
Obligers respond readily to outer expectations but struggle to meet inner expectations
Rebels resist all expectations, outer and inner alike
We all fall roughly into one of these four categories. There’s a short quiz on Gretchen Rubin’s website you can take to see what Tendency you have.
Why is it important to know your Tendency? Because knowing this one small aspect of yourself better can help you be more efficient and productive-and happier.
Each Tendency is different; there isn’t a “good” or “bad” Tendency; they are neutral. They just show you how you operate in the world when someone asks you for something or when you decide you want to do something different for yourself.
For example, I am an Obliger. I’m very reliable with external deadlines and expectations, but I often give up on things that only matter to me, like exercise or getting to bed early, in order to complete work or do something for my son.
Knowing this about myself helped me create external accountability for the things that are important to me, even if they don’t matter to anyone else. It turns out, for me, check boxes work well. Sometimes, that’s all the accountability I need.
I checked off two boxes already this week, I don’t want to break my streak!
Sometimes I need more accountability. With my charting issues, on Monday I committed to my husband that I’d have all my charts completed by Friday night (at midnight!) so I could enjoy the weekend without hiding out to complete charts. Making the commitment on Monday helped me plan my time better all week so I didn’t have 100 charts to do on Friday night!
Knowing your Tendency can be a helpful tool to manage your own life, but it’s also a great tool to help you manage your patients.
If you know your patient is a Rebel, telling them they have to start exercising is just going to guarantee they don’t start-even if they themselves want to start exercising!Use your knowledge to help them succeed. Try reverse psychology-”Don’t bother starting an exercise program now!”-or help them find a really good reason to start exercising. Maybe you can point out that they’ll live to see their children grow up if they take better care of themselves now?
A Questioner patient needs to know why you want them to take medication every day. They have high blood pressure? So what? They feel fine. Taking a few minutes before prescribing the medication to explain more about “the silent killer” may go a long way toward having a compliant patient with an improved blood pressure.
Self-knowledge is powerful, as is insight into how our patients’ think, and Gretchen Rubin’s Four Tendencies illuminate one aspect of how we operate in the world, giving us a tool that’s simple, useful, and extremely helpful. Check it out: Read the book or take the quiz.
Originally published at http://dianemackinnon.com.
