If a patient says, 'I will never do this' (such as, I will never take that medication), an effective way to respond is to say 'Can you restate that' and add 'yet'.
During a patient interview, if you as the health care provider get frustrated, it is an indication that things aren't going well. In this situation, look at yourself and ask why. According to Dr. Michael Vallis, a psychologist who gave a talk and a workshop at the CRA 2015 meeting about motivational interviewing, it is usually because a patient is not following the advice you have given or is not acting in the way a good patient should act (in your view). An important thing to realize is that there is a difference in opinion and you should invite the patient to discuss the factors and beliefs underlying their current behaviour. You don’t have to change things overnight. Indeed, many patients need time to change their ambivalence about the risks and benefits of their medications and of their disease.
Motivational communication is an area of psychology that was developed in the area of addiction. It can help patients and their health care providers gain common ground and achieve shared goals in many other chronic conditions. One mistake we often make as health care providers is going too fast. A patient is not necessarily on the same timeline that we are on in terms of their chronic disease management.
How can we do better? We can start by asking more questions that allow patients to reflect on where they are now, what is wrong with where they are, and what the future could look like if they were better. Then they may be ready to accept strategies that can help them improve.
Motivational interviewing can also help assess and improve adherence if this is a common goal for you and your patient.
Dr. Janet Pope is Professor of Medicine at Western University and Division Head of Rheumatology. Dr. Pope's research interests include epidemiologic studies in scleroderma, classification criteria in systemic sclerosis, systemic lupus erythematosus and rheumatoid arthritis.View Full Bio