Motivational interviewing: helping the ambivalent patient make a change
Motivational interviewing can help patients take a step towards better health.
As providers, we know the challenge of making a change in a patient's health. We offer suggestions and try to help, but there is often an "I wish I could but..." or "I want to get better, but I hurt too badly" in response. The list goes on. Patients often feel ambivalent about change. So, how can we make a difference when we are blocked by these comments and thoughts?
Of course, the first thing that has to occur is that the patient must actually want to change. We may think we know what is best for them, but if the patient isn't ready, it isn't going to happen. Listen for key words. There is a difference between saying "I will do something" and "I wish I could do something." “I will” statements signify commitment, whereas “I wish I could” statements signify desire without commitment. Both statements show that a patient is considering a change. Helping the patient go from “I wish I could” to “I will” is where motivational interviewing can be beneficial to your practice.
Motivational interviewing uses the patient's own motivation for change to improve their treatment. It forms a partnership between the provider and the patient. This is different from the current medical model where the provider makes all the decisions and the patient follows what the provider dictates. We all know how well that works, right?
I was introduced to motivational interviewing when I took a course on health coaching at Duke University. Later, the course was offered at the hospital where I work. If you haven't been exposed to this technique, by all means, find a class. It will make a difference in your practice and in your relationships with your patients.
We want patients to take charge of their health, yet we don't enlist them to help themselves. Patients are demanding to have more control of their healthcare. We have to find ways to help them help themselves, and motivational interviewing works beautifully. Patients are much more likely to make major changes if they feel empowered to do so.
One simple way to start a motivational conversation is to ask the patient what they are willing to do to improve on their problem and let them commit to something they are ready to change. Note it in their chart, and tell them you will ask them the next time how successful they have been. From my experience, many patients come back excited to talk about their successes. Those who are not successful have to take responsibility for not meeting their goals, since they made the goal themselves. In both cases, ask the patient what their next goal is, and encourage them to make another step towards health.
Have you used motivational interviewing in your practice? If so, what have you noted about the change in a patient's behaviors?
Sharon M. O'Brien MPAS, PA-C, is a practicing clinician with an interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.
- Rollnic S. Motivational Interviewing in Health Care. New York, N.Y.: The Guilford Press. 2008.