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Case #2: Mrs. Baxter

     Mrs. Baxter, is a 53 year-old African American mother of three and grandmother of 8. Her medical problems include diabetes, high blood pressure, and arthritis. During a recent office visit her family doctor said to her, “You still seem to be enjoying life a lot,” to which she replied, Yes, I am.” Her doctor then said, “I assume that one of the reasons you come to see me is so I can help you stay alive as long as possible.” Again she answered, “Yes.” Then her doctor asked her, “What kinds of things would you still like to see happen before you die?”

     She began talking about her grandchildren, family gatherings, graduations and marriages. Then her doctor asked, “What do you think would be the single most important thing you could do, with my help, which would increase the chance that you will live to see those things happen?” She said, “I should probably stop smoking.” When her doctor agreed, she said, “I’m going to do it.” And she did.

     Encouraging Mrs. Sawyer to focus on her goal caused her to become invested in a strategy to achieve it. And it was a strategy that she herself chose.

     In a problem-oriented approach, smoking would have been identified as one of Mrs. Sawyer’s problems, and she would have been advised to quit.   The difference between a goal-directed approach and a problem-oriented one may seem subtle, but, it is actually huge; it is the difference between a positive, collaborative approach (i.e., achievement of a goal endorsed by the patient) and a negative, directive one (i.e., correcting an abnormality identified by the doctor). The positive approach is almost always more effective because it leads to patients making a greater investment in their health care goals. And greater investment almost always leads to greater returns.

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