3 4
periodic or short duration. With the best of intentions relapse regarded." Incorporating the use of social or referent power
usually occurs within several days after reading a book or into a behavioral modification program entails three phases:
attending a seminar, or several months after the conclusion (1) building, (2) using, and (3) retaining referent power,
of a behavioral modification program. Phase I is typically established during the physician/
In contrast, computer-derived, self-adjusting motivational 5 patient information-provision stage, during which the
guidance, which interactively cues and polls the client and patient database is determined. Once established, referent
comments on his performance as he goes about his daily life power can be applied during Phase 2, with the physician
throughout the year, has a more lasting effect It differs offering both directives and encouragement to the patient
importantly from seminars and visits to counselors or with Behavior modification necessitated by a medical condi
a supervisor in that it modifies behavior at the site where the 10 tion requires that the patient subscribe to a particular medi
behavior occurs, with personal or customized intervention. cai regimen. Tailoring a regimen comprises (1) consider
The more frequent interactive dialogue between the coun- arion 0f the various facets of the patient's existing routine
selor or supervisor-controlled computer and the client or and (2) modification of the regimen to minimize changes in
employee enhances the feedback and therapeutic simulation the patient's lifestyle. The patient's cooperation is often
in much the same way as has been experienced in other 15 proportionate to the degree of change demanded of him. If
interactive communication structures, such as education and fewer behavior modifications are expected, the patient is
entertainment. For instance, consumers accord a higher more likely to adhere to the regimen,
value to interactive entertainment software than to passive ^ ^ of ^ physician-patientrelationship is critical
software, due to the greater stimulation afforded by this t0 fte success of a prescribed regimen. wim the
mode. In entertainment software, an example would be some 20 ... mterpersonal s]dlls md central to the
of the new video games that present a mode which runs like patieaVs perception of the physician. A patient responds to
an animated cartoon until one elects to interact. As an ^ forthcoming changes in his lifestyle emotionally; a
animated cartoon, the video usually becomes boring within physician responds professionally. The result is frequently a
minutes. But as an interactive video game, the software dissatisfied patient, one who sees his physician as unfriendly
stimulates the user with hours of entertainment. 25 ^ uncaring ... with this opinion, a patient is much
In our culture, it is usually assumed that, given adequate less likely to heed the parameters of his regimen. The information, people will use it rationally. Numerous studies evolution of a therapeutic physician-patient alliance can have indicated that compliance with medical recommenda- only occur if the physician conveys—both verbally and tions alone is less than perfect and generally only nonverbally—his interest in the patient, vis a vis giving a approaches 50 to 60 percent in many instances. Many patient the cathartic opportunity to tell his own story, expresphysicians assume that if an individual is exposed to verbal sions of respect and empathetic concern, information pertaining to his or her health issue, that behav- ^ research literature on social power and influence, the ioral change will take place. Given this viewpoint, the degree to which patients comply with the recommendations physician's responsibility is often seen as ending when the of health care practitioners has often been seen as directly proper words are spoken. In fact, many problem behaviors related to the physicians' use of referent, reward and coerand compliance with various medical requirements require dve powers. Generally, medical recommendations are menconstant feedback and adjustment over an extended period tally internalized by patients based upon the regard in which of time. Likewise, in other forms of education, personal hold me caregiver and the continuation of some form of management, sales and advertising, continuing reinforce- positive reward or reinforcer. However, in modern medical ment is often necessary to achieve the desired results. practice, physicians have shown that they generally lack the
Before a patient or employee can be expected to follow time, inclination or financial incentives for the continuing
the intended recommendation of a physician, supervisor or monitoring of a patient's behavior and compliance with the
counselor, he must have a thorough understanding of what prescribed regime.
is expected of him/her. One major criticism of contemporary 4J Therefore, a need exists for a computer driven interactive medical care is that patients do not receive as much infor- two-way communication link that increases the opportunity mation as they would like. The resultant dissatisfaction to create realistic and engaging behavioral reinforcement precipitates a tendency to (1) ignore the physician's or and guidance in the home or office and at remote locations, counselor's recommendations. (2) forego follow-up wyh both stationary and portable wired and wireless cornappointments and (3) "shop" physicians rather than continue 50 mumcation devices to assist the physician in the practice of with one whom he feels is too vague. medicine by facilitating compliance with medical requireIn medical practice, initially, the physician must establish ments in regard to their patients. Similarly, a parallel situa baseline of the patient's knowledge to determine the extent ation exists in business organizations for the motivation of of the patient's understanding, his grasp of the rationale employees on a continuing basis in their natural environbehind the recommended behavioral changes, and his per- 55 ment
ception of the actions such changes will entail. It is impor- Although in medicine, a physician is crucial to achieving
tant that the physician confirm the patient's understanding permanent behavior change, other components of the pri
by having the patient repeat the explanations and instruc- mary health care organization are also important. Optimally,
tions he has received, or by asking the patient to rephrase the physician-patient contact provokes a commitment from
them in his own words. Too frequently, a physician will ^ the patient and the initiation of a behavior modification
disregard this procedure because of time constraints or program. Maintenance of such change necessitates methodi
because he is uncomfortable doing so—circumstances that cal instruction, coaching, and protracted follow-up. For
need to be addressed by the physician. example, a patient diagnosed with chronic heart disease will
Of valuable assistance in successful behavioral modifica- require more than just prescribed medication. He will need
tion is social or referent power, which is defined as the 65 to institute or revise his exercise regimen, relearn cooking
"primary basis of the social action becoming a significant habits, and appraise stress-inducing activities. Such extreme
other, a person whose approval and acceptance is highly behavior modification will involve not just physician and
