Version May 2024
| Non-motivational interviewing (MI) approach: Engaging |
| The first vignette illustrates a routine clinic visit that is unlikely to lead to change, or worse, may further demoralize the patient. MI-inconsistent techniques are identified following the physician's statements. |
| Doctor: Hi Mrs. X, glad to see you today. How are you feeling? |
| Patient: Well, my asthma is acting up again. I might need a different medicine. |
| Doctor: Are you still smoking? (Closed question) |
| Patient: Yes, but I'm cutting back. |
| Doctor: You know that smoking aggravates your asthma and puts you at higher risk for other problems. (Providing information, overlooking change talk) What have you tried to help you quit smoking? (Open question, possible premature focus) |
| Patient: Oh, everything. It's so hard to quit. |
| Doctor: Well, I can write a prescription for one of the newer medications to help you quit. It's quite effective. (Providing information, likely premature focus) |
| Patient: Well, okay… |
| In above vignette, the doctor rushes to a premature solution, and misses opportunities to elicit the patient's strengths and knowledge. By bypassing the processes of collaborative agenda setting and gathering more context for the patient's symptoms, the doctor fails to elicit or build the patient's motivation to change. |
| Motivational interviewing (MI) approach: Engaging |
| Compare the standard approach above to the following MI approach. MI-consistent techniques are identified following the physician's statements. |
| Doctor: Hi there Mrs. X, glad to see you today. How are you feeling? |
| Patient: Well, my asthma is acting up again. I might need a different medicine. |
| Doctor: You're thinking maybe a new medication would help. (Reflection) Let's put that on the list of possibilities. (Avoiding premature focus, agenda setting) First, let me listen to your breathing. Okay, I hear the trouble you're having. (Providing information) I'd like to spend about five minutes talking about your asthma broadly, before we decide together on the best approach to manage it. (Agenda setting, collaborative spirit) How does that sound? (Open question) |
| Patient: OK, that sounds good. |
| Doctor: Tell me what concerns you most about your asthma. (Open question) |
| Patient: Well, it's really scary when I have an attack. I'm afraid I could die from this. But even on a regular day, I have less energy, and I feel older, due to it. |
| Doctor: So attacks make you worry you might die, and they are truly scary. (Reflection) But even on a daily basis, your life is diminished due to the asthma. (Complex reflection) |
| Patient: Exactly. It's such a handicap! I wish I could get rid of it. |
| Doctor: I bet you've thought about how you could lessen your symptoms and reduce the impact of asthma on your life. (Affirmation) |
| Patient: Yes, I have. I think the first thing I should do is quit smoking. |
| Doctor: You're clearly aware that smoking is making things worse, and you think you should quit. (Reflection) |
| Patient: Yes, and I've already cut way back. I don't smoke in the house or car anymore, and I'm down to half a pack, where I was smoking a pack a day. |
| Doctor: You've already made a serious dent in the number of cigarettes per day. (Affirmation, reflection) How has that gone for you? (Open question) |
| Patient: Well, I made up my mind, and am keeping track of my smoking. I have a chart and I check off when I have a cigarette, and I stretch out the time between them. |
| Doctor: You're really taking it seriously. (Affirmation) You're already doing some of the things that experts recommend to make quitting work for you. (Providing information) What else have you thought about trying? (Open question) |
| Patient: Well, I heard there were some new medicines to help you quit. But I figured I have to be more ready. Can you tell me about the newer options? |
| Doctor: You're not sure you're totally ready. (Reflection) I hear a lot of commitment from you in what you're already doing. (Reflection) Maybe considering a medication might be a next step to help you be even more ready. (Providing information) I'd be happy to review some of the information about the new medicines… (Providing information) …and then we can talk further about what the best next steps are for you. |
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