Marathons and Motivation: Lessons for Changing Health Care

Marathoners passing through Coolidge Corner.

Runners descended upon Boston from all over the globe to run the Boston Marathon yesterday. For many, it was their first. For others, a repeat performance. For all, the experience comes from setting a goal and finding the motivation to follow through on it. Watching them run is nothing short of awe-inspiring. I get choked up every time I stand along the sidelines cheering. Yesterday was no exception.

Why do we set goals? How do we find the motivation to achieve them? And how do we apply this to a health care system focused too little on encouraging healthy living and too much on managing disease? Running a marathon may be an extreme example, but the principles of setting and achieving a goal, at whatever level, are widely applicable.

So how do we apply ‘the marathon principle’ to health care. Let’s be honest. We doctors are really good at managing disease, but we are really bad at motivating and inspiring patients to live healthy. We aren’t trained to do it. We don’t have the incentive to do it. We don’t have the time to do it. Not that we aren’t altruistic people. We are physicians, after all. And we have the best of intentions. I often query my patients about their levels of physical activity (‘when was the last time you dusted off that treadmill in your basement?’) and diets (‘tell me what you ate yesterday?’). Hearing their responses, I tell them, ‘You should exercise more and eat better.’ Then I say, ‘I’ll see you in a year.’  This is a problem and a lost opportunity.

Opportunity lost: Imagine how much we could achieve if we could use the time between visits to motivate, inspire, and guide you to live healthy.  The old model (i.e., the current model) places the doctor at the center of the system, surrounded by a panel of patients. But what if we just shifted the framework, putting the patient back in the center, surrounded and supported by a team of individuals, not only including their physicians, but also perhaps a health coach, and a nutritionist, and a fitness instructor, and even a therapist. We need to help you find the path toward healthy living that fits best for you in the context of your own life and outside of the doctor’s office.

My husband and I after the BAA 5K.

Setting goals, real and achievable: The next step is to figure out what gets you going. A marathon may not be in your sights (frankly, it’s not in mine…), but the day before the marathon, my husband and I ran the Boston Athletic Association’s 5K road race (it’s the closest I’ll ever get to the B.A.A.’s main event!). For me, it was a real and achievable goal. One that fit within the context of my life. Maybe this isn’t goal you would set for yourself. And that’s okay. You need to find the path towards healthy living that’s right for you. And we need a health care system that helps you figure out what motivates you, helps you identify your healthy living goals, and then goes about helping you achieve them.

In Drive, Daniel Pink offers ‘the surprising truth about what motivates us.’  It’s not carrots and sticks. It’s not external rewards. It’s about finding the motivation from within. Though his examples derive from the business world, the principles are widely applicable to health care. Pink argues that human motivation is driven by three major factors: 1) Autonomy (the power to direct our own lives), 2) Mastery (the ability to learn new things and get really good at them), and 3) Purpose (the desire for our actions to have a greater meaning in the context of the world around us, for ourselves or for others). You find this inner motivation and you find what Pink and the positive psychologist Mihalyi Csikszentmihalyi call ‘flow.’ Flow is that state of complete absorption and satisfaction, being ‘in the zone.’ We need to find ways to help our patients find ‘flow.’  We need to motivate, inspire, and guide our patients forward so that they find personal satisfaction in being healthy.

Not many of us will ever run a marathon. But watch the way those runners pick a goal, work hard to master it, and find purpose in achieving it. Getting healthy starts with you setting a goal and figuring out how to succeed. What if the health care system were actually set up to help you?


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