[Excerpt from upcoming book, Prescribing Change: How to Make Connections, Influence Decisions and Get Patients to Buy Into Change] This section discusses the topic of Motivational Interviewing in health care, which I devote an entire chapter to in the book.
As a practicing optometrist, I adopted an approach of trying to uncover problems beyond “I’m here for new glasses.” I realized a lot of patients would only reveal superficial information at the beginning but would reveal additional problems as the exam proceeded. What I learned to do was elicit these problems earlier by asking better questions.
I also learned that not all problems are created equal. And by problem, I’m not referring specifically to clinical conditions. Things like lifestyle, convenience and even price can be “problems” for people. The bigger the problem, the more motivated people are to find a solution.
To quantify the pain (problem) someone is experiencing, ask the patient to offer a subjective rating from 1 to 10 measuring readiness, desire or commitment to change.
“How strongly do you feel about wanting to get more exercise? On a scale from 1 to 10, where 1 is ‘not at all’ and 10 is ‘very much’, where would you rank yourself?”
If they respond with a low number, like a 3, our reaction is often corrective. Why isn’t this more important to you? You should take your health more serious!
A response like this is likely to evoke defensiveness. An alternative approach aligned with the guiding style is to ask why the patient didn’t pick a lower number.
“Ok, why didn’t you pick a 2?”
Now, the patient has to begin thinking about why he’s not a 2? He then begins articulating his own autonomous, intrinsically motivated reasons for wanting to do something.
We know from a mountain of social science research that when people have their own reasons for doing something, they’re more likely to endorse the behavior and more likely to carry it out. This becomes a way to surface the patient’s own motivation for change by asking questions as opposed to dictating.
Another example for my optometry friends:
Clinician: On a scale from 1 to 10, how motivated are you to start wearing sunglasses outdoors?
Patient: I would say 2.
Clinician: Ok. Why didn’t you say 1?
Patient: Well, I know when I do wear sunglasses my eyes feel more relaxed outdoors. I also know that my risk of other eye problems you’ve told me about will reduce if I protect my eyes from the sun.
Notice that the patient is now expressing his own reasons for behavior change. You learn not only how important the change is to a patient but also why it is important.
Another approach is to simply get the patient to discuss pros and cons. They will then verbalize their own reasons for and against change.
This requires clinicians to do something that doesn’t come natural for us. It requires us to give up control over the outcomes. Giving up control down not mean a lack of influence, but granting autonomy to the patient is sometimes exactly what’s needed to guide him or her to take action.
Human beings only have two responses to control. They comply or they defy.
Author note: If you want to read more on this topic, I recommend the book Motivational Interviewing in Health Care, Helping Patients Change Behavior
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