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Enhancing Patient Communication: A Guide to Motivational Interviewing

Table of Contents

Key Takeaways:
  • Motivational interviewing is a quick and simple framework to learn that can transform your patient communication experience
  • You can easily remember the 4 guiding principles of motivational interviewing with R.U.L.E.
    • Resist the righting reflex, which is your desire to immediately correct deviations you see. Give the behavior change process and chance to be just that: a process.
    • Understanding their motivation keys you into the intricacies of their situation and values, ultimately giving you important insight that can help you achieve their goal
    • Listening to them allows for all of the details of their story to be told, because you can only know what someone tells you
    • Empowering them to be an active participant in their behavior change ensures a better chance the change will actually happen

You can only understand another person as well as your ability to communicate with them. This is true for any relationship that you are in, including clinical ones. Communication is a staple in the medial field, as people are coming to you to describe what they are experiencing in an attempt to seek help. They are likely uncertain or fearful about whatever it is that they are going through, and need your help to get back to their normal.

There are entire books written on medical communication, some much more confusing than others. A great place to start in the medical communication world is motivational interviewing. It can produce a quick turn around in the goal of medical communication and it is relatively easy to understand. We need not dive into the world of philosophy like some medical communication books to reap the rewards in an immediately applicable manner.

Motivational interviewing is a style of clinical communication in which we elicit from patients their own good motivations for making behavior changes. Whether you’re on board with the idea or not, behavior change is what we are after when it comes to patient communication and interaction. There is likely to be a behavior at least contributing to what it is that they are seeking your help to manage, and making adjustments tot hat behavior likely has a non-zero effect on what it is that they are experiencing.

In other words, they are doing something against their interests, and its your job to figure out how to get them to do something else. This might be that they aren’t active enough in which we want them to move away from the sedentary side of the fitness spectrum, or it could be that their is a mismatch in a thought process, expectation or belief that is fueling the fire of their symptomatic presentation.

There are 4 guiding principles when it comes to motivational interviewing. They spell out RULE

R: Resist The Righting Reflex

You as a physical therapist entered this profession to help people. You learned (for anywhere from 4-7 years) ways that people can improve their lives and their health, and you have an expertise in this field as well as a lot of answers. With that expertise, there is an intense desire to correct patients when you see that they might not be doing something right. Maybe you’re under the impression that “If only they knew what I know, that would set them straight”. While more good information is universally a good thing to want, simply delivering it to people is not enough to get them to change.

You need to resist this “righting reflex” because it can have an unfortunate opposing effect. Humans seem to recoil when they feel they are trying to be persuaded. While your recommendation may very well be a good one, if it directly conflicts with what your patients feels is a good idea or has been doing, it likely won’t be received with an open mind. In this scenario we see that there is utility in drawing out this “righting” process.

There is utility in building rapport, authority and a relationship with someone before trying to get them to see your side. You can liken this righting reflex during an initial evaluation to some stranger on the street walking up and informing you that you should add a baking soda and water mix to your ground meat before cooking it. While it might be great advice, you have no relationship with this person, likely won’t put much weight into their recommendation and might even scoff at their advice.

U: Understand Their Motivation

One thing that must stay at the front of your attention is that it is the patient’s own motivation to change that will drive the desired behavior change, and nothing else.  It is this understanding of why it is that they come to you looking for help that lights the way when moving towards goals.  If you don’t have or don’t fully understand this why, mainly the concerns, motivations and values of the person, you cannot actually grasp the intricacies of the situation at hand.

There is even utility in asking what the person feels is the best path forward when making a change, as they are the subject matter expert when it comes to the details of their own life. Letting them state out loud the means with which they feel a change can be made will help to solidify the utility of those tactics in their own mind.

L: Listen To Them

Listening is a great but difficult clinical skill to develop. As I mentioned before, you are a bank of knowledge and answers, likely hoping to jump in and save the day the moment you see the opportunity. There is a well known and unfortunate statistic of physicians interrupting their patient’s subjective in a lightening fast 18 seconds after they have begun. Butting into conversation or looking for the end of the patient’s sentence just so you can insert your 2 cents is not indicative of good listening.

Often the answers to the behavior change problem lies within the patient, and they might even be aware of the changes that they need to make. Listening for those “bright spots” can be helpful as, like I mentioned before, using the words that come from the patient to reiterate what behavior change you want will only help to solidify the change needing to be made. If they vocalize the change that needs to happen, you can simply agree and ask what they feel is the best  for that to happen.

E: Empower Your Patient

Your patient is more likely to make the change that you are hoping for if they are actively involved in making that change. Yes you can give a blanket recommendation, and some patients may be able to take that recommendation and apply it blindly, but remember that the patients are the experts in the nuances of their life. They have the insight on how this change can fit into their life, or how they are going to realistically implement it. Making the recommendation of going to the gym 4 days a week for 1 hour each can be fine for some patients, but asking a patient what they can muster regarding gym time will help mold a better recommendation.

RULE as a framework for spurring behavior change in patients is one that you can implement today, with your next patient. If you can implement all four of these guiding principles, I guarantee you’ll be impressed with how different your communication will look and feel with patients. You might even be pleasantly surprised with how behavior change attempts go.