Monday, August 26, 2013

Motivational Interviewing

One of the most difficult issues related to teaching evidence-based practice is that one of the three main planks of the discipline is relatively poorly understand often little discussed. This is patient values (the other two are, as most of us are now well aware, evidence from the literature, and clinical expertise and experience).  What do we mean by patient values, and how do we address that in the context of EBCP?

I have come across an excellent book that can help answer  that question. The book is entitled “Motivational interviewing in health care: helping patients change behavior,” by Rollnick, Miller and Butler (1). The text is designed to provide health care professionals manage patients with conditions amenable to lifestyle change. We are all involved in that as chiropractors, and in our personal lives. The current health challenge is but one small way in which we are trying to alter how we eat and what we do for exercise, just as one example. The book looks at creating and fostering more effective communication between patient and professional.  It is really about motivating change.
As the authors note, motivational interviewing  has a spirit containing three parts, which they call “collaborative, evocative and honoring patient autonomy.” By collaborative, they mean it is a collaboration between professional and patient. It removes unequal power relations which typically exist in doctor patient interactions, where we tell the patient what to do. It knows that only the patient can effect change in his or her own life. By evocative, it refers to the fact that motivational interviewing seeks to evoke from patient s something they already have, their own motivation. Instead of giving them something (a drug, an adjustment, a scolding), it looks to patient goals and aspirations and focuses on what patients care about. Finally, by honoring autonomy, it acknowledges that people are free to make their own decisions about the course of their lives. We can advise people what to do, but in the end, those same people have to decide whether or not to follow that advice. It is their decision.

I am looking into this book, so that I can begin to incorporate parts of it into my course in EBCP in the 9th trimester. But I am highly intrigued, because it also fits in with the entire concept of patient values. Motivational interviewing respects those values and does not seek to have us impose our own on the patient, as may occur in some chiropractic doctor-patient encounters. The book is well worth looking at.
References
1.       Rollnick S, Miller WR, Butler CC. Motivational interviewing in health care: helping patients change behavior. New York, NY; Guilford Press, 2008

 

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