The good thing about locus of control (see my article Different Types of Patients) as far as doctors are concerned is that it can be influenced. It is rather like political affiliation; most of us lean to the left or the right, but can be cajoled sometimes to vote the other way. Locus of control in most people is a tendency not a fixed aspect of their personality. A further point about external or internal beliefs about health matters is that we humans are not necessarily consistent. For example I may be at heart more or less a fatalist but I still buy big chunky cars believing them to be safer for my family and perhaps for me.
If it is correct that the communication strategy of the medical profession should be directed to increasing people’s tendency towards looking after their own health and taking some responsibility for their health, and most modern doctors believe it should, only the internal controllers are going to accept that idea easily. The other 50-60% of us patients are going to need a bit of persuading. However, the effort may be worth it for several reasons, not least because it is likely to lead to more of us following medical advice.
In a review of the literature in 2001 it was found that for five behaviours, the odds of healthy behaviour were more than 40% greater among individuals in the internal controller category. Fatalist scores were associated with more than 20% reductions in the likelihood of healthy options for six behaviours, while powerful others scores showed more variable associations with healthy actions.
Now a cautionary thought about control, take type 1 diabetes. Many young female diabetes sufferers discover quickly that letting their sugar levels rise produces weight loss, high sugar equals small bum. So they make a conscious risk decision to put their health at risk in the long term for short term reward. Is this internal control or fatalism? It is certainly common, ask your diabetic friends.
If we patients all require different styles of communication depending on our locus of control and research suggests that doctors have on balance pretty inflexible styles; then how are we, as patients, going to gain the necessary flexibility and communication expertise to help our doctors to help us?
The answer must be to think about real agendas, what we really want from our doctor. If we are clearer about our beliefs, and have an inkling about our own locus of control, we can try to steer our doctors to take on board at least some, not necessarily all, of our agenda, and talk to them about what matters to them and to us. Communication between us will therefore, become tailored to us as an individual and automatically becomes more flexible. This should help our doctors to help us.
I will close this article with a quote from a Doctor who survived serious illness and he wrote about it in the BMJ. Personal View: Gawain Shelford GP BMJ vol327.
“The information that I want is not that 1 in 10 patients will benefit, but whether I am that one.”
“When I return to practice after my treatment, I shall ensure that I focus on the individual in front of me and my traditional consulting skills.”