Seeing Behavior as Information

As healthcare providers do you struggle with finding patience for your patients?  Do you find yourself increasingly frustrated with patients who don’t follow your advice?

Seeing Behavior as Information

From the middle of the round pen, I watched Blitz, a 28 year-old warmblood relatively new to my herd, frantically pacing back and forth, calling out to Monarch, “his” mare who was in the pasture just across the gravel drive, less than 20 feet away.  I had hoped to work with him on some simple exercises he would need to know to work with clients.  So far, I couldn’t even get his attention.  Two years ago, I would have let his anxiety spill over me, making me anxious, frustrated, disappointed, or worse, angry that we weren’t accomplishing the goal.  I would have easily gone to those dark places.  “Why can’t he just focus?”  “He shouldn’t be ignoring me!” “He’s not good enough…. I’m not good enough.”  But on this day, after a lot of work on myself, I was able to see things differently.  OK, he’s anxious, I realized.  I thought about vulnerability and the concept of vulnerability thresholds.  Pushing a little bit out of our comfort zone is necessary for growth- maybe a 4-7 on a 1-10 scale.  Pushing out too far – 8…9…10 – elicits panic.  Ahhh, I thought.  This is too much.  I’ve thrown him into the deep end of the water thinking we were in the wading pool.  Alright.  He’s not comfortable being 20 feet away from Monarch.  Ok. No problem.  We’ll have to build up to this.

Before taking him back to her, I decided to take just a few seconds to try a new breathing technique I had learned.  I grounded myself and made my breaths even and regular.   With every in-breath I imagined drawing in joy, love, and gratitude.  With every out-breath I imagined sending joy, love, and gratitude to Blitz.  I let go of expectations.  Blitz stopped pacing.  Slowly, he swung his giant head around to look at me.  I kept breathing.  He swung his body around so that he was facing me.  I kept breathing.  He took 3 steps toward me and stopped.  I kept breathing, my face in a huge smile.  He took a few more steps toward me until he was about 5 feet in front of me.  Ahhhh.  YES.  Good boy.  That’s enough.  You are enough.  I am enough.  This moment of connection with you is more than enough.

As a physician, I wonder what would happen if we took this same approach with our patients? What if, instead of focusing on the outcome- the hemoglobin A1C, the blood pressure, the cholesterol, changing code status- what if we instead focused on the process, the conversation, the relationship with the patient or family, and trusted that the rest would follow?  What if we simply saw behavior as information?

My patient is acting out angrily.  Did I or someone else in the healthcare system cross a boundary? Or Is this existential angst (anger at God, the universe, fate) and not about me at all?  

My patient seems anxious.  Is what I’m asking too much for her right now?  What effect does it have if I ask for something less or perhaps offer additional support?  What if I focused on being completely present with her in this moment, silently sharing a sense of calm support?

By approaching behavior with curiosity, perhaps we can avoid going down that rabbit hole of self-righteousness “they’re not good enough”, or conversely, self-loathing “I’m not good enough” because what WE wanted or expected for that patient wasn’t what we were getting in that moment.

By valuing the process over the goal – connection over perfection- we may even achieve the goals more often, with patients who feel engaged, empowered, and supported.

Of course, there will be patients who won’t meet us half way despite our best efforts.  Patients who are “non-compliant” and seem hell bent on destroying themselves no matter what we say or do.  But, what if we could simply stay present with them, see their behavior as information, and stay compassionate and curious rather than self-righteous and judgmental? As with Blitz, long histories, experiences, and relationships that we know nothing about are influencing their behavior in this moment.

What if we didn’t make it all about us?