Can Behavioral Medicine Be Brought into Standard Practice?
A recent study by Johns Hopkins researchers found that phone counseling sessions before and after surgical intervention greatly improved patients' propensity to stick to exercises and rehabilitation after surgery. For practitioners, the most significant hurdle may be finding a realistic way to implement behavioral medicine—Health Behavior Change Counseling (HBCC) and Motivational Interviewing (MI)—into the spinal surgical setting.
Richard Skolasky Jr., ScD, lead author of the study and an associate professor of orthopedic surgery at the Johns Hopkins University School of Medicine, in Baltimore, mentioned that he and his team were working on developing a program to incorporate HBCC into their standard care, but experts agree the methodology largely is being underutilized.
"I think in the clinical setting it's very rare. I don't think this is filtered into clinical practice yet," said Steven H. Richeimer, MD, an associate professor of anesthesiology and psychiatry at the University of Southern California. "I think the idea of having motivational counselors and using motivational interview technique is great and should be more widespread. It's just a little hard to figure out how to get the medical community to embrace it and start bringing it in and setting it up."
Indeed, the logistics could be taxing. Degenerative spinal disorders are the leading musculoskeletal cause of disability,3,4 representing one of the widest patient groups in the nation, and it's predicted to grow even more. Spinal stenosis, the most common reason for spinal surgical intervention, could affect more than 60 million Americans by 2025.
Face to Face Counseling
To Dr. Richeimer, phone sessions can make a big difference, but face-to-face interaction with a counselor prior to surgery would form a stronger relationship with the patient. This would make phone calls following the surgery even more effective, where the patient already would have a rapport with the counselor.
Of course, doctors may have to confront their own bad habits, as well. Facilitating edifying dialogues with patients isn't always easy, after all.
"My colleagues that are in behavioral medicine, they tell me the only thing harder than changing the behavior of patients is changing the behavior of doctors."
Also, as further research is published, new tools are developed, like interactive behavior change technologies (IBCTs), which utilize internet applications, CD-ROMs, and voice-response telephone calls to educate patients.5 There seem to be an ever increasing number of tools practitioners can incorporate into their practice.
Nothing trumps the bonds formed from human interaction, though, said Dr. Richeimer. So while these tools can work well as supplements, the focus should always be on making a connection with patients and helping them to make the best effort towards a full recovery.
Mainly, the patient has to be convinced that people are paying attention – the doctor is paying attention, the physical therapist is paying attention – nobody's out there to torture them. We are out there to get them stronger, to get them rehabilitated. We'll work with the physical therapist to adjust as needed and, within reason, we'll adjust their medicines to try to manage their pain."