Abstract
Wink. Nudge. Shove.
The hollow fibre membrane module. (a) Picture of the real module, (b) staggered arrangement of the fibre bundle.
Behavioural change is a vital part of what we GPs do. It is ingrained in most of us to offer unsolicited advice on every aspect of people’s lives.
Gentle forms of persuasion are generally taught on GP training programmes around the country. Motivational interviewing is a current buzz technique. It was new to me when a colleague who had recently undergone training presented to the practice and asked for volunteers. Innocently, I said that I needed to do something about the recurrently messy table top in our kitchen and would be happy to be ‘interviewed’ by a fellow GP in front of the group. The ensuing conversation was painful. My excuses sounded feeble in the extreme and I felt vulnerable and foolish – but I gained much from the conversation. I was given an insight into the power differential in the ‘therapeutic’ relationship and, from just a single interview, I really have made a change and keep our table top fairly clear these days.
On a grander scale, the UK Behavioural Insights Team uses knowledge from behavioural science to prod people into behaviour that is better for them personally and for society. Strategies such as asking people ‘If you needed an organ, would you take it?’ when asking them to register as an organ donor have proved highly effective. I would love to see such ‘nudge’ techniques being applied more broadly to health behaviours and feel there is much more that could be done to help people make healthy choices.
Sometimes though, we all need a bit of a shove.
As a first year medical student, I joined in with the general uproar when a slightly odd graduate student proposed a ban on smoking in the bar. While few of us smoked, we believed it represented an infringement on the liberty of those who did and worried it would change the feel of the place. Two years later, when a close friend found herself unexpectedly pregnant and felt unable to enter the bar, I had an inkling that we may have been worrying about the wrong people’s freedom. Several years after that, the ban came into force and, remarkably quickly, it has become socially unacceptable to smoke in a public place. As a nation, we have been ‘shoved’ into a different viewpoint by legislation.
More recently, I have experienced another about-turn in my position on a contentious issue – the Care Quality Commission (CQC). Before their arrival at our practice, I, along with many others, worried about the box-ticking about the waste of resources and the undeserved damage to GP reputations. Our practice was in a flurry of panic for months before our actual inspection, with people requesting training records and changing the colours of the bins on a seemingly daily basis.
Personally, however, I found many of the changes to be positive. Instead of the broken blinds, we now have smart, cloudy-glass stickers over windows. We have decent surface wipes in all the rooms. Crucially, we are no longer allowed to dip urines in the consulting rooms. Looking back, how on earth could I have thought it was acceptable to open up a urine sample in a clean room and tip it down the sink?! I have been forced to write up protocols that had been on my ‘to do’ list for about a year and the quality of minute keeping at our meetings has improved exponentially. The team who inspected us were polite and professional and our feedback has been positive.
Change is hard. It is uncomfortable and challenging, but if we want to help our patients to change, if we want to improve the NHS and to build a better society, we need to understand it, be open to it in ourselves and be ready to embrace the big shoves that the country sometimes needs. Whether it be supporting the campaign for a living wage or remembering to do some brief intervention around alcohol use, GPs really can make a difference.