Reading Reflections: Motivational Interviewing in Healthcare

I had an interesting experience with Urgent Care recently. After the very last snowfall of the season, in early April, I had fallen on the slushy front steps when I went outside to sprinkle some salt so no one would fall and hurt themselves. I landed smack on my butt, and did something impressive to my tail-bone.

I couldn’t walk normally, I couldn’t go up and down stairs normally, I couldn’t sit down or stand up normally. It hurt. It really, really hurt, and it didn’t go away after a few days, and it didn’t seem to be getting any better.

After one week of hobbling around and levering myself up from chairs, I broke down and went to Urgent Care for an x-ray. I didn’t really think it was broken, and I knew that sometimes the fractures don’t even show up in the x-rays, but I thought I should get a professional opinion anyway.

It was a somewhat ridiculous experience, and I couldn’t’ quite figure out why until I started reading Motivational Interviewing in Healthcare (by Rollick, Miller, and Butler) for school.

Motivational Interviewing (MI) focuses on practitioner’s conversational skills with patients and clients to enable behavioral change. The position of the authors is very clearly that simply telling patients/clients what to do from a position of authority is an ineffective way to deliver healthcare and often highly counterproductive. Rollick, Miller, and Butler suggest that instead of directing, providers spend a little extra time (sometimes only adding a minute or two to the conversation) developing a relationship with the patient and use active listening to fully understand where a patient is emotionally as well as how they understand their situation.

Working from within that relationship, in which the patient is treated respectfully, as an individual, the provider can gently inform and lead the patient toward the changes that they need to make. By involving the patient and obtaining their cooperation in the process, the provider will find they understand the patient’s situation much better, and the patient is far more likely to follow through with the necessary change.

The problem with my experience at Urgent Care was that, despite being the only actual patient in the building, everyone was rushing around as if the queue was full of people. Conversations were as brief as possible. The doctor rushed through his examination and lectured me, delivering his words in rapid-fire. By the time I was out the door, I was dazed and annoyed. I couldn’t quite remember all the instructions he had given me. He hadn’t really listened to my description of my injury and my experiences; in fact, some of his questions were sufficiently closed that they limited the information I had the opportunity to give him.

It wasn’t a serious injury; the bone wasn’t broken. I just needed to rest it and not aggravate it. But I can see the potential for problems with such a poor interaction between provider and patient. On the other hand, MI seems to open the doors for a much more meaningful conversation, enabling a much fuller interaction between provider and patient.