What if you could impact motivation, Influence and positivity change your patient’s behavior in just 7 minutes?
Working in orthopaedics surgery over the past 18 years, I have seen a variety of patients who suffered from what we describe in healthcare as modifiable risk factors for surgery. Obesity and nicotine addictions are the two most common challenges I face in the office when discussing surgical plans with patients. When presented with a patient seeking surgical consultation, I often find myself immediately frustrated when I see the medical record reveals one or two of these markers. Before I even enter the room to discuss surgery, my mind jumps to the uncomfortable conversations and disappointment that both myself and the patient are about to experience when we discuss why they are not optimized for surgery. Lately, I have been working on better understanding this reaction and the assumptions I make prior to entering the room. It has allowed me to create space from the negative emotion and really investigate the thoughts that precede the emotion. I have discovered that it’s really my frustration of not being able to help this person that leads me to want to avoid these conversations and drives my negative emotions. I have externalized the control and given away any power I had to improve this person’s lifestyle. When in fact, I can regain some power by employing a technique called motivational interviewing to help elevate the patient’s own autonomy (Miller et al, 2013). Motivational interviewing defined by psycholigists William Miller and Stephen Rollnick as a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence.
Recognizing that I have a tool that I can use to help empower or “help” this patient in a different way from my traditional approach the visit . Even though I am not able to help this patient by offering them surgery today to fix their arthritis knee, I can help motivate them to choose the path that allows them access to surgery in the future.
Now, many of you may already be saying, I don’t have time nor the desire to have a mental health visit in this 15min time slot of my day. The answer is actually you do. There are techniques described in motivation interviewing that begin with a series of prescribed questions that only take about 6min to do. In Michael Pantalon’s book, Instant Influence, he describes a model of motivational interviewing that can be done at an office visit, in the ER or in the hospital room in just 7minutes . These questions can provoke meaningful insight and allow a shift in mindset that allows the patient to be more likely to succeed in losing weight or quit smoking. Motivational interviewing techniques are rooted in the concept that focuses on the patient’s autonomy and discovery of intrinsic motivators . As he describes in the book, the first goals that motivational interviewing have are to create the “will” and then begin to define the “way” .
Check out this quick video to learn more about Michael Pantalon and his technique. https://vimeo.com/87482809
This simple but powerful set of tools can be taught and providers can have a new approach to seeing these challenging patients in the office. Rather than dread the appointment, you can work toward honing your motivational interviewing skills to help patients find success and eventually surgery if this is what they wish. Example questions used in motivational interviewing center around “Why” questions that discover the intrinsic motivation and help reduce resistance to change . Example of a series of questions you can use as a provider:
1. Why might you consider losing weight ?
2. How ready are you to consider losing weight on a scale of 1-10?
3. Why don’t we pick a lower number?
4. Imagine you were to make a change, you don’t have to , but what would be the positive outcome for you? Not anyone else but you .
5. Reflect back to question 1’s answer, Why is that reason important to you? (you may continue to drill down on reason/response given and ask again) I heard you say ____, but why is THAT reason important to you ?
6. What’s your next step?
With these series of questions, you have engaged the patient, focused them, evoked a new insight and then created a step that moves them to action. Of course, this using these “canned” questions in the beginning will feel robotic and unnatural but didn’t we all start out that way. As we learned to interview patient’s in our medical programs, we were given the same kind of recipe of questions to use until we gained more experience and found our style of drawing out what is pertinent in the conversation.
Use these questions in practice and see the shift that happens. Notice what happens with your interaction with the patients but also what happens before you enter the room. If you might consider rehearsing these questions with patients, how would that help you? Would it make you feel like a version of helping that is acceptable now? I think it may, but more importantly , I want to know what outcome is important to you. Why is changing the conversations with these patients important to you?
What’s your next step in leading in medicine?
· I hope you noticed in the above final paragraph another example of motivational interviewing style and how it can reduce your resistance as a provider to consider this approach.
For more information and scientific evidence about motivational interviewing check out:
o “Instant Influence”: Dr. Michael Pantalon’s book
o Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd edition). Guilford Press. Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd edition). Guilford Press.
Comments