Habit Stacks

This year I am required to complete a Practice Improvement module. While I can embrace the spirit of the requirements set by the American Board of Family Medicine(that are put in place to help physicians stay proficient since medicine advances at lightning speed) I do resent being told how to do it. As if by completing this task it will make me a better doctor and without it, I would not stay up to date on my own. Can you hear the enthusiasm in my voice as I tell you how excited I am about these obligations?

Negative thoughts plague my mind and keep me stuck: “I don’t want to do a project.”  “ I don’t have time to do one more thing.” Or my all-time favorite: “I can’t want to!” (This is what my grandson says when he gets stuck.)

After five months of procrastinating, I concluded my resistance was not changing the ABFM. And frankly, my resistance was not serving me.  I still had to choose a project.

Could I think about it differently?

I have to do a project to complete the requirement if I want to maintain my certification, which I do.

How can I make it worthwhile for me, so I actually learn and grow?

How can I make it valuable for my patients that they would somehow benefit?

How can I check the box and get this dross off my to do list?

In other words, could this be a win-win-win? The answer was a resounding YES, I reasoned and felt my mind shift from obstinate and contrary to accepting and even excited.

So what was the next actionable step? Hmmmmm…..

We work on behavior change a lot in my medical practice which focuses on lifestyle to improve health. We work with people to figure out how to stop unhealthy habits and form healthy habits. Admittedly, change is hard.

One strategy I had been highlighting lately is habit stacking. Habit stacking is where you add a healthy habit you have had a difficult time implementing to a neutral or healthy habit that you are already doing. Stack the new habit on the old habit and the old habit will serve as a cue for the new habit.

For example, I have a hard time drinking water while at work and wanted to figure out how to drink more.  Every day as I get to the office, I am already in the habit of unlocking the door, turning off the alarm, and putting my bags in the break room. I do this every day without fail.  Putting my bag in its place could serve as a cue to turning on the water for the tea I am going to drink all day to stay hydrated. I was already in the break room where the water and tea lived. It would just take a few more seconds to get the tea set up. I set my mind to it at first, but now I am on autopilot. Put my bag down, turn the tea pot on. As a result, I have been more successful hydrating with water and herbal teas. And the automation of this habit frees me to take care of other things.

Could I use habit stacking as a Practice Improvement project? Why not?

With the advent of electronic medical records, people are used to receiving automatically generated visit summaries to remind them of their diagnosis and treatment plan.  

I see the value of a visit summary and want my patients to understand and follow through on their treatment plan. My current EMR system does not have this feature, so I have to create it manually. It requires intentionality on my part every time. And frequently I forget.

I decided to make this my project.

Create a meaningful treatment plan summary. Figure out how to habit stack it to automate the process. And then follow up with the patient in one week to see if they were implementing or had any questions or ran into any barriers which we could address before time got in the way and nothing was accomplished between visits.

What was something I was already in the habit of doing at the end of every visit which I could stack the visit summary and follow up text or email to? The answer was obvious: the patient’s invoice.

I create an invoice for every patient visit and I was already attaching it to an email. It would only take another 60 seconds to add to that email a summary of the salient points of the visit, what we agreed the patient was going to work on until the next visit. I usually summarize verbally with them anyway. I could write and talk at the same time. And let them know I would follow up with them in a week to see if they had started the medication or got their lab work drawn or implemented the lifestyle change goals.

I was elated with the possibility of this win-win-win situation. A win that patients would receive something meaningful. A win that patients would have additional support in to accomplish their goals. A win that I was modeling the habit stacking I was preaching. And a win that I could cross something off my to-do list.

And I could have been doing this all along.

We all encounter barriers to change. One of the biggest barriers are the negative thoughts we cling to, sometimes without even knowing it.

It took thinking differently about the situation for me to take action. Instead of seeing the ABFM requirement as a chore or albatross, I saw it as an opportunity. My thinking had to change before my behavior changed.

What healthy habits are you putting off implementing that need a fresh perspective? What habits are you already doing that you onto which you can stack another healthy habit? Think different, weigh different.