It's one of the great frustrations of medical practice – no matter how often you advise patients to stop smoking, reduce their alcohol consumption, or eat more healthily, they seem to ignore you.
Most of us are uncomfortably aware of our bad habits but it doesn't mean we are ready to change our behaviour. The drive to make lasting changes can really only come from within and this is where a patient-centred type of consultation called motivational interviewing (MI) can make a difference.
Rather than lecturing patients, MI uses an empathetic, collaborative and non-judgmental approach to engage with patients. It aims to elicit the motivation to change from the patient and support self-sufficiency by encouraging them to focus on their strengths, recognise how their behaviour might jeopardise their health and give them the confidence to commit to change.
MI was pioneered in the 1980s for addiction counselling by Stephen Rollnick and William Miller. NICE now recommends using MI in treating alcoholism and substance abuse. However, you could also find MI methods useful when trying to build a rapport with patients, when you want someone to change their lifestyle for the good of their health or to comply with treatment.
MI uses the following techniques to draw out patients' ideas and solutions:
- Ask open-ended questions. Invite the patient to consider how and why they might change. This allows you to move the conversation forward constructively.
- Recognise the patient's strengths. Make statements which help patients to see themselves in a more positive light and believe that change is possible.
- Use reflective listening. Actively listen to the patient and demonstrate your understanding of their emotional state and point of view by using reflective learning statements, and through your own body language and verbal communication. A key part of MI is picking up verbal cues which reflect a patient's state of mind, from preparing to change to actively committing to it.
- Summarising. Recap what has been discussed during a consultation, drawing patients' attention to anything they have said which indicates a desire for change or readiness to move on.
As well as helping you to address patients' lifestyles more effectively, the principles behind MI are central to ethical practice. Of course, MI techniques are likely to test your consultation skills at first but with training, supervision and feedback on performance they can be a powerful asset so it's worth understanding them fully and practising them before you qualify. To find out more, ask your supervisor or visit stephenrollnick.com
This guidance was correct at publication 15/11/2013. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.