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 9^th 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

 

My Most Influential Business Books

I have become somewhat addicted to books about business, largely because I find so much in them that I can apply to my work here at Palmer. The following list is not all-inclusinve but dodesl ist some fo the books that have affected me the most.

1.  Leading Change, by John Kotter. Kotter’s book makes so much sense to me each time I go through it. He has an 8-stage plan for leading change, and demonstrates how to involve everyone in the process. He also discusses the pitfalls involved and how to avoid them> Much of his approach surrounds the importance of “vision.” There is much to be found here that applies to academic practice, where change is necessary if we are to survive.

2.  Good to Great, by Jim Collins. In this book Collins dissects why some companies thrive and grow while others in the same sector fail. He finds commonalities between those who succeed. Much of what he found can be summarized as: the best companies found and promoted the right people who acted in a disciplined manner to get work done. In this, Collins discusses his “hedgehog concept.”

3.  The Effective Executive, by Peter Drucker. Drucker is the dean of executive leadership studies. His book notes that the measure of an executive is the ability to get the right things done. This stresses imagination and intelligence. The best executives manage time well, know how to mobilize strength for effect, set priorities, etc.

4.  The Magic of Dialogue, by Daniel Yankelovich. Dialogue here refers to “carefully structured communications” designed to create mutual understanding. In this book, the author provides a number of different approaches designed to foster better communication and create dialogue between colleagues to enhance trust and effectiveness.

5.  Made to Stick, by Chip Heath and Dan heath. This was a book recommended to me by Bill Meeker, and it looks at why some ideas stick while others do not. Clearly, this has applicability to the chiropractic profession as well as to chiropractic education. The goal of this book is to help explain why ideas stick, and to enhance the probability yours will do so.

6.  The Servant Leader, by James Autry. This is about managing with respect, honestly, love and spirituality. It is not religious’ don’t get the wrong idea. But it places the leader in position of being servant to those he or she leads.

This is just a few of many books that have helped guide my approach to leadership, management and personal effectiveness.

Tribes

In his presentation that opened our 2013 Homecoming celebration, Dr. Marchiori based his Prezi session around the concept of “Tribes.” This comes out of the small book by Seth Godin, also entitled “Tribes,” wherein a tribe is defined as “a group of people connected to one another, connected to a leader, and connected to an idea.” (1) Using this definition, you can see that we are members of many different tribes. One might relate to our religious beliefs, another to our professional status and yet a third to our hobby or avocation. In all of these, all that is required is a shared interest and a means for communication.

Palmer College is a tribe, of course.  There is an idea driving Palmer College of Chiropractic: that is The Trusted Leader in Chiropractic Education. And around this idea is a community, wherein we unite behind the leader to help ensure that our idea hold true. In our tribe, we do not just come to work in order to do nothing more than earn a paycheck; we derive satisfaction from our work because it is a community effort to ensure we live up to our ideal. We no longer want to avoid change, we wish to embrace it. We don’t fear change; we look for it.

Because we look for change, all of us have to become leaders. It is not just the boss who leads, but all of us, and this is an expectation. We have the ability to do so and are encouraged to do so. Change agents are desired in today’s marketplace. We have them here and they are making a difference. And it is not so much that this requires work; it turns out it can be fun and rewarding. New connections between people are forged.

Godin is only writing about how organizations can more effectively be responsive to a changing and challenging marketplace. Palmer cannot rest on its laurels, and it cannot continue to address opposition from within. Change happens and is necessary, and unity and tribal membership is a means to ensure that people are happy, productive, and contribute to the common good. In the end, the beneficiary is the student, and by extension the public our students will later care for.

References
1. Godin S. Tribes: We Need You to Lead Us. New York, NY; Penguind Group, 2008

Evaluating Health Resources on the Internet

The National Center for Complementary and Alternative Medicien at NIH has provided a brief overview of how to evaluate web-based  information related to the CAM field. This is located at http://nccam.gov/health/webresources?nav=tw. The entry notes that there are a growing number of health-related websites, and these offer information that ranges from incredibly trustworthy to completely useless or even dangerous. With our students using the web on a more frequent  basis, it might be a good time to remind them how to evaluate such sites.

First, the article suggests that the reader look to see who runs the website. It should be easy for you to identify this, and the ownership should appear on each web page. Corollary to this is to identify who pays for the website, as this may not always be the same as who owns it. An initial way to do so is to look at the ending of the url, i.e. gov (a governmental site), .edu (an educational site), .org (an noncommercial organizational site), etc. Look to see how the site pays to exist; is it via advertising or some other fashion. Is it sponsored by a drug company or a technique vendor? This can be a key to assessing the information on that site. It is not likely, for example, that a site sponsored by a drug company will present information counter to drug company advertising.

Then, look at the purpose of the site. This can often be found in the link to “about this site” that is usually placed on the home page.  Look at the various information links and sources; these may often be from other sites, and if so, that should be clearly labeled. The site should also give you information on where they are obtaining evidence. Is it from journal articles, and is it evidence-based? Or are there only testimonials?

How is the information the site presents selected? Are you given information about this. Are there links to other sites, and can you trust them? Are you asked to “subscribe” to the site (which then allows the site to track you and target you with messages in the future).  If they do, they should tell you what they do with the information they collect. Note their privacy policy so you know how they might share that information.

In the end, the goal of assessing the site is to gain useful information, often to be used in managing a patient. Teaching our students to be able to look not only the information but the provenance of the site is an important means of ensuring that best management options are then used. The web may now be our collective memory but some of what we remember is not always good.