Chicken Soup for the Patient's Soul...and Yours, Too

A Worldwide Phenomena

The original Chicken Soup for the Soul book was published in 1993. Since then, more than 500 million copies of the book series have been sold in 43 different languages. The authors, Jack Canfield and Mark Victor Hansen, are motivational speakers who sought to publish a book based on the notion “that people could help each other by sharing stories about their lives.”¹ The premise of the book was to catalogue the goings on of real-life people, with real-life challenges, tragedies, and triumphs. More than 250 versions of the franchise have been published, many with health care themes, such as cancer, as well as Alzheimer disease and other forms of dementia.

Each Patient's Story is Unique, But Offers Broadly Applicable Attributes

The tried-and-true format for the chicken soup books are the short and succinct storylines of the people featured throughout. Each page encourages the reader to understand someone else’s life experience and relate that journey to their own lives. A remarkable connection with each character occurs, despite the reader being in a different life circumstance than the author.

This parable format of writing relies on analogies to motivate the reader. The stories themselves are formulaic and are always 1200 words or less, in the first-person voice, set the stage by describing everyday life, and finish with a subtle lesson to be learned or reminded of.

Be it our training, convention, or natural tendency to plod through the work day, we tend to think and operate in terms of the medical model, with a scientific and calculating focus on the pathology, diagnosis, and treatment that produces a patient encounter that, like the chicken soup books, is also formulaic but unfortunately lacks the character development that makes those books so effective at engaging readers.

It is all too easy to review the lab results and initiate the drug regimen with no further discussion other than, “You are supposed to take 1 tablet, twice a day,” which is a generic message based on generic information inputs. Yet no 2 patients are the same. Each has their own experience, with unique perceptions of their disease and manner in which it affects their daily lives.

Every Patient Drug-Use Story Has Distinct Goals and Health Concerns

Two patients living across the street from each other, with the same employment profile, gender, age, laboratory findings, and chronic illnesses, with the same prescribers, can still have completely different life experiences and relationships with their medications. One may live with family, and the other may be single without social support. One may metabolize drugs differently and experience adverse effects, while the other may simply be forgetful. Or it could be a lack of emotional investment in his antihypertensive medication because he does not feel the effects of the “silent killer.” Such lack of investment perhaps affords him the self-rationalization of “I can’t afford my medication.” One patient’s relative is in his ear every Thanksgiving about naturopathic and alternative medications, while the other is sick of having to get up in the middle of the night to go to the bathroom. One aspires to run road races with his grandchildren, while the other is mostly concerned about not feeling old.

Patient-Centered Care and Motivational Interviewing Go Hand-In-Hand

Motivational interviewing (MI) is a technique first developed as a method of augmenting interventions aimed at reducing dependence on alcohol that has now been applied to all service lines health care, as well as the broader fields of consumer and behavioral economics. This year, a study found that health professionals who had recently been trained in MI had substantially higher appreciation for the value of patient-centered care. Specifically, the Rodriguez study found that: “More professionals trained in MI compared to those trained in [adherence previously, but not MI], considered that, ‘simplifying treatment as far as possible’ (85.6% vs 68.9%, P = .0077), ‘involving the patient in treatment plans’ (85.6% vs 71.1%; P = .0187), ‘giving the patient self-care patterns’ (52.2% vs 36.7%; P = .0357), and ‘performing MI’ (42.2% vs 15.6%; P <.0001)” were the most important interventions to promote adherence. “Empathy between doctor and patient” (93.3% vs 77.8%, P = .0036) and “concordance of medical and patient treatment goals” (96.7% vs 72.2%; P <.0001) were the factors perceived as having the greatest influence in improving adherence to asthma treatment by the physicians in the MI group as opposed to those in the [trained in adherence but not MI] group.²

MI is rooted in the notion that human beings are rationale in their own minds and a fundamental understanding of their individual rationalization is essential to promoting behavior change. As Alistair and Latchford put it: “[MI] strategies are more engaging than coercive, more supportive than argumentative, and any health professional can learn to use the 4-step framework. The first step involves beginning a conversation, so the factors bearing influence on adherence can be aired in a supportive environment, where the possibility of change is raised. Expressing empathy through reflective listening (reflecting back what some- one has said and sometimes expressing your own thoughts on what it means) is an important part of this.”³

Each patient has a drug use narrative of their own, unique as a snowflake, even if they can be categorized into the broad categories of drug therapy problems such as “nonadherence” or even more narrow categorizations, such as “patient cannot afford medications.” Answering the key question of “Why isn’t the patient taking the medications as prescribed?” requires depth and narrative with full context to arrive at solutions that are patient-centered and effective.⁴

Chicken Soup for the Pharmacist's Soul

One interesting byproduct now of more than a decade of maturation and implementation of MI in practice is the positive effects of professional fulfillment. Studies have recently discovered that health professional burnout can be dramatically reduced after they implement MI into their practices. So, get to know patients beyond their therapeutics and labs and diagnosis. Listen to their stories. Understand their reasoning and rationale. It may provide you with chicken soup for yourself.

Troy Trygstad, PharmD, PhD, MBA, is vice president of pharmacy programs for Community Care of North Carolina, which works collaboratively with more than 1800 medical practices to serve more than 1.6 million Medicaid, Medicare, commercially insured, and uninsured patients. He received his PharmD and MBA degrees from Drake University and a PhD in pharmaceutical outcomes and policy from the University of North Carolina. He also serves on the board of directors for the American Pharmacists Association Foundation and the Pharmacy Quality Alliance.

References

• History—Chicken Soup for the Soul. chickensoup.com/about/history. Accessed December 28, 2017.
• Román-Rodríguez M, Ibarrola-Ruiz L, Mora F, et al. Motivational interviewing for adherence: post-training attitudes and perceptions of physicians who treat asthma patients. Patient Prefer Adherence. 2017;;11:811-820. doi: 10.2147/PPA.S127645.
• Duff A, Latchford G. Using motivational interviewing to improve medicines adherence. The Pharmaceutical Journal. https://www. pharmaceutical-journal.com/learning/learning-article/using-motivational-interviewing-to-improve-medicines-adherence/20200954.article. Pblished May 17, 2016. Accessed December 28, 2017.
• Pollak KI, Nagy P, Bigger J, et al. Effect of teaching motivational interviewing via communication coaching on clinician and patient satisfaction in primary care and pediatric obesity-focused offices. Patient Educ Couns. 2016;99(2):300-3. doi: 10.1016/j.pec.2015.08.013.