Ask, Don’t Tell: How Motivational Interviewing Can Spark Patient Participation in Health Treatment

As physicians, we get used to prescribing: try this medication, do this exercise, check back with me at this time. This is only natural since patients come to us for answers and expertise, and in some situations a prescriptive approach may be the best. However, when it comes to chronic conditions such as obesity, cardiovascular disease, arthritis, and hypertension—conditions that often call for sweeping lifestyle changes to be treated effectively—simply telling a patient what to do may be useless or even detrimental. It may make them feel as if they are trapped in an authoritarian relationship, enduring the discomfort of long-term change on someone else’s terms for someone else’s reasons while their concerns go unaddressed.

Those of us in obesity medicine know all too well that such a relationship is unlikely to inspire dedication to any treatment plan you choose. So, why not bring the patient’s own impetus for getting healthy into the picture? The path to patient-centered treatment is with motivational interviewing.

Research-based Approach

Motivational interviewing is an effective tool for providers facing the challenge of getting patients to engage in their own treatment. Research shows that this method can have a significant effect on behavior changes such as smoking cessation, weight loss, decreased alcohol use, and increased physical activity.

The foundation of motivational interviewing is a style of communication that differs from what we often use in our practices. Motivational interviewing focuses on identifying the patient's own reasons for change and elicits patient input as a treatment plan takes shape. Once you understand why the patient wants to change, you can harness that motivation to help them become healthier.

Improve Your Relationship with Patients

Your relationship with your patients can improve dramatically through motivational interviewing. By avoiding the authoritarian “I am the expert, you are the patient, therefore do what I say” pattern of treatment, you also avoid making your patients feel ineffectual or unable to act without permission. This rapport becomes important, offering the patient the support to participate in and carry out the therapeutic program that the two of you design.

A practitioner who can find a balance between offering evidence-based advice and nurturing a sense of ownership and accountability in those they treat is likely to see improved patient commitment to treatment plans, and in turn better health outcomes.

Four Steps to Success in Practice

The key to implementing motivational interviewing in your practice is, well, practice. Creating a treatment plan with this method involves 4 steps:

1. Identifying the patient’s motivation for change
2. Reinforcing that motivation
3. Developing patient-specific goals to achieve change
4. Providing follow-up support

Keep these steps in mind whenever possible as you talk with patients and elicit their input. If you have a patient with hypertension, for example, find out what prompted their visit. Do they want to avoid chronic illness? Be healthy for the sake of their family? Whatever the reason, reinforcing it by reflecting the patient’s statements back to them, and building on that motivation with therapies tailored to their needs, will lead them toward success.

We may be accustomed to more prescriptive, less personal styles of communication, but research suggests these do not work well in the context of long-term lifestyle change for chronic illness. Just as our patients may need to create new habits for their health, we may need to create the habit of communicating in a spirit of compassion, patience, and guidance.

If you want to learn more about motivational interviewing or become a member of the Obesity Medicine Association (OMA), go to https://obesitymedicine.org/.

To register for OMA’s Overcoming Obesity 2021 Conference, where practitioners will learn about cutting-edge developments and actionable healthcare skills like motivational interviewing, go to https://obesitymedicine.org/fall/.

Nicholas Pennings, DO, is board certified in Family Medicine and Obesity Medicine as well as a fellow of the OMA. He is an associate professor and chair of family medicine at Campbell University School of Osteopathic Medicine, where he serves as the director of the Campbell University Health Center. An executive director of clinical education for the OMA, Dr Pennings is a champion for advancing the education of current and future health professionals. He has coauthored core curriculum for obesity education, developed obesity education content for the OMA and is researching the relationship between endogenous insulin production, insulin resistance, and weight gain.