September 26, 2018
I have found it helpful for myself and participants in my motivational interviewing trainings to summarize key concepts or take aways from the information provided. From my perspective of many years of training practitioners on patient centered conversations, these ten key thoughts provide a strong foundation of the learning. Narrowing these 10 down can be helpful.
10. Provide a strong introduction to who you are and how you want to work together for them to be the healthiest they can. “I want to partner with you on your health journey.”
9. Let the patient chose the next step, plan or goal. Find a focus together on a single behavior, an action, that the patient is willing, ready and that is important for them to work on.
8. Assist the patient in breaking down the next step or goal into specific steps using the SMART acronym. Specific, measurable, action oriented, realistic with a time deadline. “I will walk around my block for 20 minutes, 3 times a week on Sunday, Tuesday and Thursday evenings at 5:00 p.m. beginning this Sunday. I will check back in with you in two weeks.” Have a follow up time set.
7. Minimize the “righting reflex” where we want to problem solve, fix it, or come up with the ideas for the patient. Evoke from the patient what their ideas, suggestions and ways to deal with the situation would be. Use open ended questions. “What ideas do you have that could assist in this situation?” And then listen.
6. Have the patient restate and summarize the conversation. Sometimes known as “Teach Back”.
5. Have you, the practitioner, summarize the conversation focusing on the positives and “change talk” the patient has stated. “You are ready to take your medications as prescribed as you understand the importance of being consistent and you have decided to use a medication box starting tonight.”
4. Ask permission before giving information or advise. “I have some thoughts may I share them with you?” This gives the individual a sense of control in the conversation.
3. Look for what the patient is doing well and provide an affirmation. “You have worked hard to include more fruits and vegetables into your diet.”
2. Reflect what the patient has said especially at the beginning of the conversation, so the patient knows you are listening. Reflect rather than asking questions. When in doubt, reflect.
1. Listen to understand rather than to reply. Listen with eyes, ears and heart. And smile.
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