November 19, 2015 by Nicholas Spence
BMJ has a series of highly relevant learning modules for a cross section of health professionals, which are accessible to anyone who signs up for free at the website. I recently completed the module called “Motivational interviewing in brief consultations.”
About one hour in length, the module was developed by Stephen Rollnick, Nina Gobat, and Jacqueline Batson. It provides a brief overview of motivational interviewing, highlights the ways it facilitates positive outcomes for patients, and touches on the research supporting its use. What I was particularly impressed with was the demonstration of its applications, in the context of common issues in clinical settings, ranging from clinician time constraints to non-compliance of patients across a variety of lifestyle, behavioral and pharmacological treatments. For example, many clinicians may be able to relate to one hypothetical scenario: a 60 year old man comes into the clinic to see his GP for a medication review. The patient takes verapamil (160 mg three times a day) and ramipril (5 mg once daily). His blood pressure is currently 138/88 mmHg, with a BMI of 37. The patient is explicitly dissatisfied as the GP is running way behind schedule; moreover, in addition to the medication review, the clinician wants to raise a tough subject, body weight, and the patient becomes angry. How would you handle this consultation and turn it into a productive interaction?
Indeed, the use of role playing videos and a list of questions at the end of the module reinforces the main theoretical and clinical points.
Even for those individuals with experience in motivational interviewing, I think the module is a good refresher and reminds us that practice, particularly listening, is central to becoming a skilled interviewer. As Dr. Rollnick mentions in his closing statements of the module: practicing to listen to patients or other people in our lives is never a bad thing!
I hope the following overview and clinical tips from Dr. Rollnick and colleagues encourages you to work through the module to gain a deeper understanding of motivational interviewing:
- Motivational interviewing is a patient-centred style of consulting that can be useful in guiding conversations about change.
- It relies on using people’s own motivation to change, and is done with or on behalf of patients, not to or on them.
- There is a body of emerging evidence to suggest that it is modestly more effective than traditional advice-giving within a number of different clinical situations.”
- Often patients have heard the logical arguments in favour of change many times before.
- Ambivalence (feeling two ways about making a change) is a normal part of the change process.
- Within motivational interviewing you can, and should, offer expert advice where appropriate, while at the same time emphasizing the patient’s autonomy and freedom of choice.
- You aim for the arguments in favour of change to come from the patient rather than from you.
- It often also requires repeated consultations with patients, as setbacks (“relapses”) are viewed as an expected part of change.”