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. [ Music ]

20 comments

  1. Thank you for posting this terrific set of videos. These are so well done and terrific examples of both anti-MI practice and exemplary MI practice. These videos will be a tremendous resource for individuals who are trying to learn and master MI techniques for health behavior change. Thanks again!

  2. These videos are very helpful in learning effective motivational interviewing practices. Thank you for posting these.

  3. WOW! What a difference in an approach from an ineffective physician. Great example of how we should communicate with our clients

  4. Unlike the ineffective physician, this physician does an excellent job of showing empathy. She also repeatedly uses mirroring techniques and build's confidence and self-efficacy by using the scale of 1 to 10. Excellent in helping the client build her OWN goals! BL, ND, JG

  5. The physician often repeated back to the client what she had already verbalized, but in different words. The use of mirroring like that is important when counseling clients in need of behavior change. She also never seemed judgmental, which is essential to creating a positive relationship with a client. CB, LS

  6. These videos are great demonstrations of MI. Do you know who I can talk to to get permission to use them for small group teaching? Thank you!

  7. Hi Dr Merlo, writing from Acumentra Health, Oregon's Quality Improvement Organization (QIO)and seeking your permission to use this videoand the ineffective version as an opener for a face to face event on July 31st. We are hosting an event on "Bridging Communication Gaps in Primary Care and we think this would be a great videos to differentiate between effective and ineffective use of communication.

    Great video!

    Tara McAdoo 503-382-3935

  8. Hi Tara,
    You are more than welcome to use the videos. Please be sure to acknowledge the grant that funded it (listed in the video description and credits).
    Thanks!

  9. I agree — this a great example of motivational interviewing. There was a two-way interaction in this scenario and the provider asked the client what she thought was manageable . It was also good that she asked about her confidence level and what the perceived barriers were in the current situation, compared to what motivated her to stop smoking in the past.

  10. Sure, you have my permission. Please acknowledge the grant that funded the video production (listed above). Good luck!

  11. Dear. Merlo Lab:
    My name is Gabriela Buela, Iam family doctor from Hospital Italiano de Buenos Aires Argentina I am doing training with a health team. I am seeking your permission to use these videos, I would like to use it to show an example of motivational ineview in a couse. Thank you. Gaby

  12. ANYONE MAY USE THIS VIDEO FOR EDUCATIONAL PURPOSES. YOU DO NOT NEED TO CONTACT ME FOR PERMISSION. PLEASE ACKNOWLEDGE THE GRANT FUNDING CITED ABOVE, WHICH MADE DEVELOPMENT OF THIS VIDEO POSSIBLE. THANK YOU!

  13. I really enjoyed these two videos. Great examples demonstrating the process of working with the patient to achieve progress and a desire to change their lifestyle.

  14. Heloisa, you can use it for educational purposes, but not if you are publishing for financial gain. The funding agency would not allow that. Thanks!

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