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Ask the Expert: Helping Patients Be Health SMART

Q: How can I help my patients with goal setting?

One of the ways to help your patients with goal setting is to help them set SMART goals.

Are your patients health SMART?

Struggling to get your patients to change their behaviors for the sake of their health?  For example, maybe you have told them to decrease their blood glucose level by managing their diet or going on medication.  Rather than medication, your patient has decided to manage their weight and incorporate more exercise into their daily routine.  However, while having good intentions, they are struggling to make a change. 

On average, you have fewer than 15 minutes with a patient in a traditional one-on-one appointment.  During that time, you are addressing all the patient’s medical concerns, conducting an exam, and answering their questions.  How do you have time to work with your patients to change behavior?  Are you repeating the same educational information and trying to elicit the same behavior change with several patients? 

Shared medical appointments (SMAs) provide a team approach to seeing 8 to 10 patients within a 90 minute medical visit.  A key team member is the behaviorist or faciliator.  The behaviorist can ask the patient questions to best understand the motivation for behavior change and help patients in setting goals.  Additionally, the behaviorist assists with patient education and encourages peer interaction and support. 

One strength of a SMA is the support provided by other patients.  Ideas are generated, questions are asked, solutions to barriers are discussed, and successes are shared.  Rather than fitting in the time to work with patients one-on-one, you and the behaviorist have the benefit of working with several patients at the same time within the SMA.

How can you assist your patients with making long lasting lifestyle changes?  During the SMA, you and the behaviorist can help the patient create a clear vision of their ultimate goal (i.e., lower blood glucose level by managing my diet).  Then, create a clear plan to achieve the ultimate goal.  A key aid in making a lifestyle change is goal setting.   Better understanding of feelings, needs, and desires uncover your patient’s motivation and how to elicit sustained lifestyle changes.  Despite understanding underlying motivation, that alone will not help triumph against barriers and obstacles that patients are sure to encounter.  Goals provide a clear vision of what we want to achieve, and how to achieve it.  Would you advise patients to undertake a project without clearly defined goals and objectives?  Why approach health in a different manner?

Goals should be SMART. 

So, what is SMART?

Specific

A goal should be specific.  Setting a goal that is too vague makes it difficult to determine whether or not a goal has been obtained.  For example, a goal of, “I will lose weight” is too vague.  How can you determine if you have reached your goal? A more specific goal would be, “I will lose 5 pounds in the next two months.”

Measurable

A goal should be measurable.  Often we set a goal that is not measurable.  For example, a goal of, “I will eat more fruits and vegetables” has no measurable parameters.  A measurable goal would be, “I will eat a piece of fruit with each meal and include one additional vegetable with dinner.”

Achievable

A goal should be reasonable and achievable.  Frequently, we set aggressive goals that are not practical or attainable.  In this way, we set ourselves up for failure, and are more likely to abandon goals.  A goal of losing 20 pounds within a month is not realistic.  A more realistic goal would be, “I will lose 5 pounds within a month”. 

Realistic

A goal should be realistic.  It is important to honestly evaluate yourself with regard to a realistic goal.  You may want to be a professional tennis player, but if you do not have the talent, time and means to dedicate to becoming a professional player, the goal is not realistic for you.  A more realistic goal may be, “I will run a marathon within the next year”.  You have the time, ability and commitment to obtain your goal.

Time

The goal should be defined within a timeframe.  Having the timeframe provides structure to your goal with a specific time to achieve the goal.  For example, if you want to run a marathon, set a realistic time to train, and register for the marathon next year.  Set your training goals with measurable, time specific training distances to ultimately reach your goal of a marathon.

An example of a SMART goal is: 

In order to manage my blood glucose level, I will lose 10 pounds in 3 months and increase my physical activity to 30 minutes three times per week.  I will modify my breakfast to include fruit and oatmeal five days per week, eliminate my daily snacking, and include 2 vegetables with dinner rather than pasta six days per week.  I will walk 30 minutes during lunch on Monday and Friday for one month, and increase to Monday, Wednesday and Friday after one month.

Bottom line – Shared Medical Appointments and SMART goals work well together in changing behavior.