Homework Questions #4
What are your general reactions to the way the physician used MI to shape these brief conversations with his “patient?” What, if anything, would you have done differently? Why?
MD confirmed Pt.’s diagnosis of COPD and acknowledged that she had not been feeling well. MD let Pt. established her goal of cutting down and eventually quitting, while also honoring the admission of lacking confidence. MD encouraged Pt. to articulate the benefits of smoking; socializing, relaxation, stress relief and also the consequences; breathing, general cost, physical appearance and health. MD helped Pt. take control as a prelude to quitting; making mindfulness a first step in gaining control. “Be mindful of every cigarette you smoke.” Ct. agreed to keep a written tally of her smoking for a week; change talk, action plan, commitment to action. I don’t think I could improve on how the MD handled the situation. He motivate the Pt. to do an informal cost benefit analysis, contemplate change despite lack of confidence, suggest “baby steps” to initiate change talk and a change plan, and committing to the change plan and a follow up one week later.
What are your thoughts on how the physician used MI to help this woman resolve her ambivalence about quitting, develop discrepancy, and increase her confidence about quitting? Which MI strategies were used to help her resolve ambivalence, develop discrepancy and increase confidence? Be specific.
MD honored her admission that she didn’t have much confidence that she could quit smoking. Ct. apparently recognized the need for a change by reviewing the costs and benefits of smoking cessation. Ct. came back the following week having smoked 2 less cigarettes per day than before she initiated here change plan and the MD recognized this success. This appeared to strengthen her confidence and diminish the ambivalence. The Pt. also recognized that she struggled not to smoke when socializing and when inactive. Ct. contemplated starting a hobby to keep her occupied and to reduce times of boredom.
Evaluate the physician’s efforts to adapt MI to a series of brief interventions in a primary care setting, focusing specifically on his use of Asking, Listening and Informing? Be specific. What are your thoughts on the “patient’s” reactions to his use of MI? Be specific.
I’ve got to say, the time the physician spent with this patient is considerably longer than has been my own personal experience and also of taking Ct’s to see their medical providers. That being said, the amount of time and patience he spent with her resulted in telling her opening up and revealing what she needed (quitting smoking r/t to her respiratory issues), as well as specifically admitting to him that she did not have much confidence in her ability to quit. He met her where she was at from the onset and allowed her to process the costs and benefits of smoking, deciding on cutting back with the end result of cessation. He suggested starting small with being mindful of when she smoked and keeping track of it for 1 week. When she returned he praised her success on cutting down instead of telling her she could have done better. This allowed the patient to observe situations where she was triggered to smoke; socializing and idle time; ultimately coming up with a plan to overcome this; starting a hobby. Ct. ultimately reduces her cigarette consumption to 20 per day and commits to quit completely in 30 days. MD offered Pt. further options of counselling and medication; both were considered by the Pt. This probably would not have been the result had he MD used the dictatorial approach; telling her what she had to do rather that give her the opportunity to participate in her own treatment planning.
Take a moment to reflect on the course material over the past four weeks and the new insights you have gained about Motivational Interviewing and the specific MI skills you have developed. How do you envision bringing this new insight and these skills into your work with people who are considering changing health or health-risk behaviors?
It is apparent that it’s best to take a softer approach with a Ct. to effect behavioral change rather than expound on the consequences of the behavior that the Ct. has exhibited – and may or may not be open to changing.
I’ve since tried to meet my Ct’s where they are at and try to be non-judgmental and allow them the space to weigh the pros and cons of maintaining the status quo or making a change to the behavior at hand. I’ve found that, by doing this, the chances are better that the Ct. will make an informed decision and start discussing and implementing his or her own change plan. The chances seem to be better that they will follow one that they came up with are better that if I constructed it and directed them to follow it.