NHC: Motivational Interviewing While Working with Patients
Posted on: June 9, 2020San Francisco
National Health Corps member, Shivani Bahl, blogs about her experience implementing motivational interviewing while working with patients.
From Pearls to Seeds
I had a friend in high school whose solution to everything was a heaping dose of motivation. Got a bad grade on a test? Have a quote about failure paving the way to success. Face a barrier planning a club event? Here’s a short video about how adversity fosters determination. Exhausted from an overload of work? Read this article about how reprioritizing can change your life! He would spend hours prying open oysters, finding these pearls to present to us on open hands.
At the time I dismissed his endeavors as silly, albeit endearing. Motivation was simple to me, you studied when you had a test, you planned if there was an upcoming event, and you slept when you were tired. You did these things because you had to do them. I thought this pursuit to discover and extract motivation was a trivial quest which had no merit in the practicalities of the day to day.
Eight years later, I found myself in a conference room, spending a full day studying the five to seven words which might indicate an individual’s shift from pre-contemplation to contemplation, the first steps on the path to behavior change. In Motivational Interviewing (MI), we call those words change talk. MI is the practice of using open ended-questions to tease out an individual’s impetus to make change for themselves, in other words, to find their motivation. It is a tool used by clinicians to help people locate in themselves the strength and persistence it takes to repeatedly, drudgingly, do the work to become a healthier person.
Many clinicians have been trained in MI and use it in their practices every day. However, in the short twenty minutes providers have with patients there is often too much content to cover to use this tool effectively. On average, it is estimated that patients understand only about half of what providers say during regular visits1 and retain even less. In an ongoing effort to build effective systems which support healthy behavior and prevent escalation of treatable illnesses, primary care teams have been working on team-based care2 which offsets the burden of health care maintenance from providers to other staff like social workers and pharmacists.
Enter health coaches whose primary objectives are to help patients identify motivators and assist them in creating goals. Through working with patients, I found that motivations for change were complicated and deeply personal. A patient wanted to stay off narcotics so he could eventually meet his sister’s children, another desired to do meditation to ease the stress of constant car sickness, a third agreed to try yoga because nothing else eased the pain and she wanted desperately to play music again. These conversations had the unexpected consequence of making me re-evaluate my own motivations to change. ‘You do things because you have to’ no longer cut it for me anymore.
Looking back, I realize that what I had once thought of as pearls -pretty little things with little practical value meant to be stored away and brought out to show-off at parties- were actually seeds. Seeds meant to be planted and cultivated until they grew into something solid, beautiful, and lasting.
Citations
1) UCSF Center of Excellence in Primary Care. Health Coaching. pg. 22. . The Regents of the University of California. 2014
2) Bodenheimer, Ghorob, Willard-Grace, Grumbach. The 10 Building Blocks of High-Performing Primary Care. Annals of Family Medicine vol. 12 no. 2 pg. 166-171. April 2014
