Thursday, April 09, 2009


yesterday was interesting. we spent the morning learning about motivational interviewing. while some residents were less than excited, this is actually something i am quite interested in. basically, it's a technique of working with patients designed to help them implement positive changes in their lives. as the website puts it, "motivational interviewing is a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence."

in less fancy terms, it is an interviewing style that avoids 'doling out advice' (sometimes second nature for physicians!) and instead focuses on getting patients to explore their own personal reasons for making a change. time is spent exploring readiness for change, building confidence to make change, delving into barriers, and having the patient (again, not you!) come up with some strategies and goals to work on for the next session.

a brief example:

mother of 100 lb 4-year old: i know it's not the best, but tina just loves sugary drinks and just can't seem to go without.

instead of responding with:

doctor: well, tina just NEEDS to stop drinking 8 gallons of bug juice per day. it is not good for her, will cause her to have many problems down the road, and i want you to stop. she's 3, so it's obvious she's not going to the store herself. stop buying the crap!

you affirm the patient's statement . . .

doctor: "it sounds like helping her give up bug juice will be a challenge for you because she asks for it and gets upset when she can't have it."

and then get the patient to brainstorm about ways to fix the problem . . .

doctor . . . so, can you think of any strategies that might work to help her cut down?

as you can imagine, this is just the tip of the iceberg. there are many nuances to the style and lots of clever tools designed to get the patient to explore motivations and generate solutions, but i have to get running so this is just a taste.

anyway, why am i so into it? in addition to my own fascination with self-improvement (why do you think i make umpteen new years' resolutions every january?), i actually think this will be very useful in my future career of pediatric endocrinology -- more so than placing umbilical lines and performing intubations!

diabetes (either type!) is a disease with enough upkeep and self-care that would make even the most organized, together person's head spin. if you think it's hard to eat a healthy diet, try making time to do so AND check your blood sugar before every meal, appropriately dose your insulin, and record everything to boot. i personally don't have experience with this, so i can only imagine how hard it might be, in patients ranging from a teenager who has 8,824 other things on her mind to a 3-year old whose parents are also juggling the demands of several other children.

i know it will be a very important part of my job to spend time with patients/families helping to motivate them to manage the disease in the best way possible for them, and this is not going to be easy. i believe (and research supports!) that the motivational interviewing technique can be very effective when used properly, so i'd love to become a master of it someday.

and then i can write a book and go on oprah and become super-duper-rockstar rich and famous, while helping out my patients at the same time. ka-ching!



workout: 50 minutes on the elliptical (6 "miles) + 30-day shred, level 2. i used 5 lb weights for almost all of this shred (couldn't QUITE hack it on the last set of v-raises!). i will admit that i really did NOT want to face jillian at the end of my day yesterday, but i'm glad i did.

reading: a pediatrics article on weight gain after adenotonsillectomy. the authors tried to establish a causal relationship, with the idea that adenotonsillectomy --> overweight. i was not convinced. we are using the article for a journal club discussion for the rotation, and i think it will be interesting.

flossing: yes.


atilla said...Best Blogger Tips[Reply to comment]Best Blogger Templates

ka ching!

inmytummy said...Best Blogger Tips[Reply to comment]Best Blogger Templates

I feel the same way about 5lbs on the v-raises. I had to "follow Anita and only lift them halfway" because I couldn't find any soup cans or anything lighter.

Susie Q said...Best Blogger Tips[Reply to comment]Best Blogger Templates

I love that you tracked your flossing! I always feel like I really did something great for myself when I floss. It`s that extra step toward health!

Very interesting information about interviewing. I love that kind of stuff.

D10 said...Best Blogger Tips[Reply to comment]Best Blogger Templates

I can definitely see the motivational interviewing having better results.

Are you still running the marathon in May?

rebecca said...Best Blogger Tips[Reply to comment]Best Blogger Templates

and the sad thing is, there would be way fewer teens having that 8,825th thought in their mind had some preventative action be taken way earlier. but i guess you got to deal with the situation as is, and hope that that will have positive effects for future generations.

also, i'm assuming you make suggestions should the parent not be able to come up with any solutions using the whole interview technique... like focusing on non-food rewards / nourishing the child in other ways...

Jess said...Best Blogger Tips[Reply to comment]Best Blogger Templates

Can't you just grab the parent's shoulders, shake them, and scream, "You are giving your child diabetes!"?


Susan said...Best Blogger Tips[Reply to comment]Best Blogger Templates

Sounds like "motivational interviewing" is what we called "therapeutic communication" in nursing school. Which, by the way, was what we spent an obscene amount of time on. Many questions on tests involved picking which was the "best" response to something a patient said. Or, we had to record a conversation with patient and then analyze it and write about the techniques we used. Basically the idea was that you focused on the patient and what he was feeling...because if you were in tune with the patient, then they would be more likely to do certain things. Example: Don't say "it's time to take a walk now." Instead, say, "When do you think would be the best time to take a walk? Before dinner, or after dinner?"

I think it makes total sense that it would work, but sometimes I think people need worry less about being polite and just tell them what they need to hear. I don't mean that in a mean way...although maybe it comes across as that.

Sorry for the novel. :)

Aimee said...Best Blogger Tips[Reply to comment]Best Blogger Templates

We studied motivational interviewing in nursing school! You know what's really funny? I was thinking about buying the book for you a while back! I think it can be enormously helpful-- though I don't really find myself using it that much on the night shift ("What do YOU think you could do to stop jumping out of bed every five minutes and setting off your bed alarm?"). And "pre-contemplative" sounds much more empathetic than "non-compliant".

sue said...Best Blogger Tips[Reply to comment]Best Blogger Templates


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