As I write this blog, I am on an airplane to Las Vegas to delivery a lecture at a conference, Master Clinicians in Psychopharmacology, on adults with ADHD to almost 200 psychiatrists from around the country. I have just finished watching a program on TED TV by Thomas Goetz on formatting medical information for patients’ better understanding. The premise is that people will change their behavior if information is presented in a personally and relevant format. And on the surface, we would all nod our head “yes” that makes sense.

However, public health message with regards to smoking for decades was very slow to change behavior despite the known severe health risks of chronic lung disease and lung cancer.  After 25 years of treating my patients, I think there are other factors in changing behavior that are specific to individual people. Understand that I have an undergraduate degree in psychology, 1 year of post-graduate research in psychology, and 1.5 years of formal training in cognitive therapy and behavior therapy in addition to medical school and a psychiatric residency at Johns Hopkins Hospital.

Research has repeatedly demonstrated that fear (scaring people to change behavior) has a very short-lived effect. Public health campaigns that take this tack are often disappointing in their results. You might say that the smoking campaign was effective in this regard. However, I ask you “How many decades did it take to lower the smoking rate in this country?” Cost effective? You answer the question.

So, how does all this relate to what you do, Dr. Goodman? I treat patients with mood/anxiety disorders and ADHD in people ages 16 and older. There are several reasons people continue to take medications regularly.   Three principle themes arise in my conversations with my patients:

1. Quality of Life
2. Tolerance of side effects
3. Denial of illness/disorder/dysfunction

Which of the three is the most critical to adherence to medication and treatment? I believe it is quality of life. Now, each person will define this term differently and it is my task to help a person define it for him or herself. For some, it may be work productivity and self-confidence, for others it may be improved family relationships, and for others it may be self-reliance, the confidence “to be able to take care of myself.”

So, each time you take a pill, you ask yourself “Do I really need this?” The answer depends on the measure of quality of life. If you believe the quality of your life is better on the medication, you take it. If you question whether the medication is improving the quality of your life, you hesitate and may “forget” to take it to “see what happens.”  When I speak with my patients, this is a theme we spend time discussing.  If I have the sense that the person has a sense of diminished improvement in quality of life, as they have defined it, I can anticipate that they may stop the medication in the near future.

Researchers have spent a lot of time providing medical information to people only to be left puzzled as to why people didn’t change their behavior. “Don’t they know it is good for them?’ Yes they do, “but what impact will the change have on the immediate quality of my life?” Answer this question relevantly for the person and there is a good chance people will change. The art of therapy is to find that meaning for each one of our patients.

As always, I appreciate your interest in my writings.

David W. Goodman, MD