I agree that a motivational approach can lead patients to behavioral change more successfully than a monologistic approach. However, Dr. Manoj Pawar’s article, “Five Tips for Generating Patient Satisfaction and Compliance” [June 2005], is as monologistic as the approach he hopes to avoid. Dr. Pawar states that to be successful in motivating a behavioral change one must make the change more palatable. But what is the motivating factor for physicians to change? And how do we motivate patients in the context of a 12-minute visit that already includes history, exam and treatment?

Author’s response:

Dr. Stello raises two good points that I didn’t address in the article because of space limitations. He is correct that physician change and motivation is critical for successful adoption of any new concept. We have found that a dialogue-based model has been successful in motivating change, even in groups facing significant crisis. One major challenge for physician leaders is to understand their colleagues well enough to know what drives them to change.

Dr. Stello also raises an excellent point regarding time limitations. Visits are rushed, and innovative approaches to the current patient encounter models are needed. The more we learn from experimentation, and the more we share this information, the more likely we’ll be able to cope.