The Root of Patient Problems: What is the Smallest Action that Matters?

The Root of Patient ProblemsDuring a recent health policy training session I attended, medical and cultural anthropologist Peter Locke recounted an interesting story about a war amputee in Sierra Leone who a member of his team had approached about pain management.

Many people–up to 7% of the population–in Sierra Leone are living with traumatic amputations following their civil war. Due to the way these amputations were performed, survivors live with chronic pain. One humanitarian worker asked an amputee when his stump gave him pain, and he responded:

“It hurts when I am very hungry and don’t know where to get food to eat.”

The patient was saying, in a convoluted way, that the true problem he was struggling with was less the (real) pain from his amputation and more his food insecurity. His medical problem became an outlet to discuss his more pressing need.

This reminded me of one of the principles of engaging a patient that my team in the United States uses. We talk about pinpointing and addressing “the smallest action that matters.” By this, we mean exactly what the amputee from Sierra Leone was expressing: the true root of the patient’s problems that might keep him or her from seeking medical treatment or sustaining lifestyle changes.

Someone worried about where the next meal will come from is probably not going to focus on medication adherence, especially if buying pills comes at the expense of buying food. In less dire examples, someone who smokes as a way to ease tremendous stress won’t be motivated to give up cigarettes until that stress is otherwise released. Likewise, it doesn’t help an obese patient to understand diet if her spouse is the one who controls all of the dinner decisions for the household. In each of these cases, a different problem must be solved first before other health issues can be addressed.

The challenge for health coaches and behavior change experts, then, is to probe with patients to understand the root of the problem. What is the smallest action that matters, and how can we help address it?

The answer may bring us outside our traditional methods of helping people. But in the long term, they may help us achieve our core aim of improving the health and happiness of those we want to help.