Reply To: Week 4 Homework Assignment (Applications of MI)

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Question 1
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?
It was good to see a PCP use these skills and well. I like using visuals and probably would have used them. I like “taking dictation” of the plan that the patient has decided on, so they get a copy and it’s in the chart to refer to the next session.
Question 2
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. I liked how this PCP used complex reflections to help highlight her reasons for quitting as well as the ways that she had been successful (if even briefly) in the past. He had her identify what she likes about smoking- I imagine that with some folks that question might take them aback and invite some new ways of thinking. He checked in with her to make sure that he was understanding her correctly and invited her to make corrections- to she was teaching him rather than just being lectured to. Asking her about why she didn’t pick a lower number on the confidence scale meant that she talked about the small ways she was confident and gave herself some positive feedback.

Question 3
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. He used the tools of asking, listening (repeating to her what he understood with amplified reflection) and then asking if he could provide information often. I noticed the patient respond positively to his genuine praise/amplified reflection and she sounded much more confident and less scared by the third session. I also note that the second session was only 3min and yet he still accomplished a great deal with the pt. Often I hear from PCPs that there is not enough time to do this kind of work. I believe that use the ask, listen and informing is a good plan when starting a medication to minimize risk and encourage pt autonomy.

Question 4
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? This is the second course I have taken this year about using MI. I have been finding that these skills come to mind more often and I can use them with more ease. I would like to figure out how to use them more successfully while doing an assessment in the time allotted. I find that I need to practice patience and sit with my own “righting response” and let the process work, though the pressure to stay on time pushes me to be more directive. I would also like to have more chances to do peer supervision with others using MI, I think it would help with model fidelity.