Tom has been your patient for five years. He suffers from hypertension, is 40 pounds overweight, maintains a diet of fatty foods, and incorporates little movement in his daily routine. You’ve prescribed medication to get his blood pressure under control, and you’ve talked at great lengths about the need to eat better, move more, and adhere to his medication. Yet year after year he returns to your office, prescription unfilled, and no change to his physical condition.
Nonadherence to medication schedules by patients with chronic illnesses has long been recognized as a problem. It is estimated that approximately 50% of patients follow treatment recommendations. As a healthcare professional, you know that nonadherence doesn’t end at medication regimens. It encompasses behaviors such as smoking cessation, diet adherence and exercise.
Do you get frustrated with your patients not listening to your pleading to make seemingly simple lifestyle changes?
This frustration is bound to happen if you see patients as collections of problems and pathologies. When we realize that we cannot push, pull or drag our patients to change their behavior, we open the door to a new conversation: One that centers on relating to the fact that all people face struggles with change.
One way to transform the conversation about change is to use Motivational Interviewing (MI).
Motivational Interviewing is a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.
MI gains little momentum or effectiveness if you only think about problems. By way of illustration, consider the difference between these two accounts of the same person:
“She’s 46, female, 2 children, second marriage; chest infection; obese for many years; leads an inactive life. She’s a moderate to heavy drinker, smokes, and has a diet that is high in fried food, with little fruit or vegetables.”
“She’s 46, an account manager and mother of two; very determined person. Its her second marriage, and she keeps a keen eye on her children’s well-being. It’s a happy house. They work and play hard. She feels unwell with a chest infection. She has lots of friends, smokes and drinks, and gets little exercise. She likes to make sure everyone has a good filling meal, and this often means fried food.”
In one sense you have a choice about which of these two people you feel like working with. Motivational interviewing won’t get off the ground unless we allow the human spirit in the second account to grow and develop.
The questions you might ask will be less dependent on the person’s condition or problem, and will be focused more on harnessing internal motivation:
- What kind of change makes sense to you?
- Why does this change make sense?
- How might you achieve this?
- What help or advice might you need from me?
- How might you find a way through that feels comfortable and manageable?
By asking these questions, you settle yourself and your patient down into a helpful conversation about change, and you guide them into why and how they might shift their behavior. In MI, you don’t present the arguments for change, they do. And in doing this they harness their own internal motivation to change.
If you’re ready to change the conversation with your patients, I encourage you to learn more by watching my free CE seminar: Motivational Interviewing in Healthcare.
Stephen Rollnick, PhD