The Effective Physician: Motivational Interviewing Demonstration
>> Watch what happens this
time when the provider cues
into what the parent is saying,
empathizes with her situation,
and attempts to work
with the parent
to find a solution
that fits her needs:
>> So I wrote a prescription
for antibiotics for Aiden.
>> Okay.
>> I did want to
talk to you though;
I’m a little bit concerned
looking through his chart
at how many ear infections
he’s had recently.
And I noticed that you
had checked the box
that someone’s smoking
in the home.
So I was wondering if you
can tell me a little more
about that?
>> Well, um, it’s just me
and him and I do smoke.
Um, I try really hard
not to smoke around him.
But I — I’ve been
smoking for 10 years except
when I was pregnant with him.
But everything is so
stressful being a single mom
and having a full-time job.
So it’s just, that’s why
I started smoking again.
>> You have a lot of things
going on and smoking is kind
of a way to relax and destress.
>> Yes. Yeah, some
people have a glass
of wine, I have a cigarette.
>> Sure, and it sounds
like you’re trying not
to smoke around him.
Why’d you make that decision?
>> I know it’s not good for him.
I mean I’ve read those things
about ear infections and asthma
and stuff and — but other
kids have ear infections
and their parents don’t smoke.
>> So on the one
hand you’re worried
about how your smoking
might be affecting him
and on the other hand
you’re not so sure
if it’s really the smoking
that’s causing these problems.
>> Right, yeah.
I mean he doesn’t have asthma.
He — I don’t — he hasn’t
had a lot of other problems
that his other friends have.
So and I’ve thought about
quitting before in the past
but I just don’t see how
it’s possible right now.
>> What made you decide to quit
smoking when you were pregnant?
>> Well, he was inside me and
we were sharing everything
and I knew that he would get
some of that and I didn’t —
I just didn’t think I
could live with myself
if something happened to him.
>> Right now, though, it
feels almost too difficult
to manage or even to try.
>> Yeah, exactly.
>> How were you successful
when you quit before?
>> I don’t know, I think
about it now I don’t
even know how I did it.
I just did it.
You know, I just couldn’t
imagine like him not being born
or going into labor early
and him having problems
and stuff like that.
All the stuff that they talk
about with women who smoke.
So that was just enough to
say okay, you know what?
I’m not going to risk that.
So —
>> The risks were so scary then
that you were able to stop.
>> Yeah.
>> But they don’t feel
as scary to you now.
>> No, I mean we’re
two separate people
and like I said I don’t —
I try really hard not
to smoke around him.
I’m pretty good about that.
I don’t let other people
smoke around him, so you know.
>> You’re doing the
best you can do.
>> Yes. Yeah.
>> Okay. But it sounds
to me, too,
like part of you really
does want to quit.
>> Yeah, I know that I need
to and I — you know I keep,
every New Year I say this
year I’m going quit smoking.
But then something happens
and it just doesn’t —
quitting just doesn’t happen.
>> It’s on your to do list, it’s
just not making it to the top.
>> Yeah.
>> If you did decide to
quit, on a scale of one to 10
where one is not
at all confident you don’t
think you could do it
and 10 is you feel pretty
certain that you could,
where do you think
you fall right now?
>> Probably like a 5, kind
of in the unsure area.
Like, I know I’ve done it
before so I know I can do it,
but at the same time it
just seems really hard,
and it’s not the same situation.
>> Sure. Well what made you
say 5 rather than 2 or 3?
>> I know all the ways it’s
bad for me and I don’t want him
to grow up thinking
that it’s okay to smoke.
I don’t want him to use any
kind — I don’t want him to chew
or anything like that.
So I know I need to, especially
before he gets old enough
to understand what
mommy’s doing,
but I just don’t
know if I can do it.
>> Okay. So it sounds
like you have a lot
of reasons why you’d
like to quit.
You have been successful
quitting in the past,
and right now you’re just
feeling a little bit hesitant
about your ability to do it.
>> Yeah.
>> Where do you think
we should go from here?
>> I don’t know.
I’d like some help.
I just don’t know what
kind of help I need.
>> Sure, well if you’d be
interested that’s something I
can definitely talk
to you about.
There are a lot of new options
that can actually help
people be way more successful
in their attempt at quitting.
There’s different
medications you can try.
>> I don’t like medicine.
>> Okay. There’s also a lot
of support groups and classes
that you can take where
you have other people
to go through it with you.
Sometimes just having that
support can be a big part of it,
especially for people
like you where smoking is
such a stress reliever.
>> That sounds nice,
but I’m not sure
if I have the time for all that.
>> Sure, it feels like something
that would take up a lot of time
and maybe not fit
into your life.
I wonder if we could
talk about some options
that might fit into your life?
>> That would be really nice.
>> Okay. Well if you’re
willing, then we could set
up another appointment
where you could come in
and we could talk
more about that.
>> I would like that.
That would be great.
>> Great.
>> Thank you.
>> Sure.
>> This time, the provider
had the same agenda to talk
to this parent about the
dangers of secondhand smoke,
and to counsel her
to quit smoking.
However, this time the
provider’s focus was
on the parent’s own
view of the issue.
By giving the parent an
opportunity to reflect
on her situation, the provider
was able to elicit reasons
for change from the
parent herself.
There was no need
to lecture or scold
because the parent was making
her own case against smoking.
Many times, our patients
already have the information
that we try to give them.
What they really need is
someone to listen to them
and to help them sort out a plan
that will fit in their life.
By accepting and
respecting our patients,
even with their faults, we
communicate our genuine desire
to help them make positive
changes in their lives.
During this interaction,
the provider demonstrated
that she understood
the parent’s struggle
and that she still
wanted to help.
As a result, this single parent
found she finally had someone
on her team.
This increased both her
interest and willingness
to try working further with
the provider to find a solution
that would fit in her life.
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