Motivational interviewing was most likely a part of your training. So consider the emails this month as a review and refresher of a well-researched tool to help with behavior change in your patients. In the past, when a patient seems unmotivated to change or take advice of a clinician, the assumption has been that something wrong with the patient and there is nothing you can do about it. In fact, the research shows that motivation for change is malleable and is impacted by the relationship with the provider.
Motivational interviewing has four guiding principles, which follow the acronym R.U.L.E.:
- Resist the ‘righting reflex’ or desire to correct the patient. Paradoxically, this often has opposite effect because our natural inclination is to resist persuasion. “In some, if you are arguing for change and your patient is arguing against it, you are in the wrong role. It is the patient who should be voicing the arguments for change.”
- Understand: It is the patient’s own reasons to change and not yours, that are most likely to trigger behavior change. Be interested in your patient’s own concerns, values, and motivations. Listen for change language, like “I wish I could….” or “I want to be around to see….” (see last week’s email for more examples.)
- Listen: When you take the time to listen, even for a few minutes, patients feel like you have spent longer with them than you have. Focus on open questions rather than closed questions. Closed questions ask for specific information that the questioner thinks is important; open questions give the patient a chance to talk about what they believe is important. Examples of open questions include “How are you feeling today?” “In what ways has this interfered with your life?” “What are you most worried about?”
- Empower your Patient: Help them see how they can make a difference in their health. For instance, you know that exercise is a good thing for them, but they know how they can best fit it into their lives. Let patients become your consultants in how they can best accomplish the behavior change.
Whether this is new information or a refresher, motivational interviewing can help your patients and many of these principles are helpful in other relationships outside of the exam room as well.