One of the tricks in Medicine is knowing how your patient is motivated to do things – and appealing to their particular approach.

 

I knew a patient whose cocaine dealer would intermittently shoot at him. I pointed out if he didn’t go to the crack house, he would not get shot. I tried to make a simile;  If I kept going to a certain restaurant because the salmon was good, but the waiter always beat me up, I wouldn’t go any there more.

 

He replied “Doc, with that approach, you are going to miss out on a lot of good fish.”

 

Ah well.

 

One of my teachers thought people fell into 2 categories when it comes to motivation……

 

The first category is “my type of people” – people who do things because they fear consequences. For example, I don’t do drugs as I fear I would get sick or in trouble. I studied hard because I feared I would not get into medical school.

Nowadays I go to work, take exercise, and pay my taxes etc. all with some fears that if I don’t do these things, there will be consequences.  (I won’t have any money, I’ll get fat/have a heart attack, the neighbors will talk etc.)

 

The fellow in the salmon example is part of the second category of people. They do things because it feels good. They don’t think of the consequences of their actions. It is no good warning them their actions will have dire consequences; it doesn’t register.

I recall watching Bill Clinton’s blue dress scandal with my father. “What was he thinking of?” my father asked out loud. Well, that is the point, he wasn’t thinking. He does things because it feels good. At the time he was feeling ‘Gee, this would feel great.”

He wasn’t thinking ‘I wonder what this would sound like on CNN”.

 

People in both categories find the other way absurd.
Consequence-people” think pleasure people foolish.

“Pleasure-people” find consequence people dull and missing out on things.

 

People who do street drugs often are in this 2nd category of people. There is little good trying to tell a substance abuser ‘If you do drugs your health will suffer’. If they thought like in the first place, they wouldn’t be doing drugs. With this group, I have to use an approach that entices something good to them, like “If you stop using drugs, your ability to get an erection will come back and you could have sex again.’