Below are the episode show notes and transcript. Some episode transcripts have been edited more than others, but they are up in the meantime to help those who would rather read and for searchability on the web. Extensive editing has not been prioritized as I seek to both produce regular content and maintain my own wellness. Enjoy!
What did you say? Is that what was heard? What are the goals? Whose goals?
Come hear how you can catalyze transformation for your patients by listening well and using motivational interviewing.
Three steps we will cover in this episode…
• Make a connection
• Assess readiness to change
• Consider options together
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Hey there? Are you even listening to me anymore? I asked you over and over lately to make some changes, did you even bother to try them?
Am I talking to you, fellow physician? Or are you talking to your patient? Your family member? Someone else in the community?
How’s that strategy and tone of voice working out for you? Are you catalyzing the change you were hoping to? Or is it just backfiring on you?
If you are wondering how listening and behavior change might go together in your life and your medical practice, please stick around, this episode is for you.
Welcome to the MedEdWell podcast, where physicians get empowered to take the next step in their wellness, personally, professionally, and financially. I’m your host, Dr. Ryan Stegink, a practicing general pediatrician and online entrepreneur.
Again, welcome back to another episode of The MedEdWell Podcast. We are already to episode 10. Yes, you heard me right, 10 episodes in already. I am so encouraged by those of you who continue to listen and share with your colleagues and other physicians.
So today, we will be discussing the importance of empathic listening and motivational interviewing. This not only helps catalyze and facilitate behavior change for your patients, but it also can help you in your wellness journey. Professional wellness and purpose can be advanced by reframing our roles as physicians. Rather than simply telling patients what to do and writing a prescription, you can help educate and empower them to help them choose the next step to advance the care of their own health, even as you have specific thoughts and recommendations for them to consider. It is a mindset shift because it comes alongside them with education, seeing them as a person, rather than placing my feelings about the care I provided solely on their outcome or how they responded to what I presented as my recommended next step for them.
Before we dive in further on this episode, let’s hear from today’s sponsor.
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Alright, now back to today’s show.
Back in my first year of pediatrics residency, I was an intern on the developmental pediatrics inpatient service. It wasn’t my first month, but in reality, every month of intern year felt like a crash course in a new area. I was trying to figure out where things were on the floor, who to talk to, who needed followup with the specialist or just their primary doctor. I was trying to learn about the common things I would see, in addition to the particular conditions I was seeing in my patients at that time.
So that developmental pediatrics inpatient rotation. There were a variety of reasons why patients would be admitted to that service, whether complex medical needs or sometimes it was the babies or young children who were having difficulty gaining weight. Various criteria put children into the failure to thrive designation or diagnosis, one of which is being below the 3rd percentile for weight on the appropriate growth chart. It doesn’t mean that they are necessarily behind on their development otherwise, but adequate weight gain and brain growth are correlated early in life. There are a variety of reasons why patients don’t gain weight as expected, from malabsorptive disorders, other medical conditions, specific feeding challenges around oromotor skills or swallowing dysfunction, and sometimes there are psychosocial challenges, dealing with a child’s personality and prior habits around food consumption.
Stick with me, I’m going somewhere with this story, though for all you out there who are still deciding on a specialty or subspecialty, come join pediatrics, I think it’s great. Continuing with the story, so in addition to treating the underlying conditions that may be there, a large part of the medical team’s work is to empower and coach the parent on feeding their child. Whether it is fortifying formula or whatever nutritional supplement they are using, whether it is helping them with the structure needed around mealtime and snacks rather than grazing throughout the day. Lots of options to talk about.
So there I am, the first year resident, leading family-centered rounds for the my patients I am caring for. I am an introvert, a thinker, and sometimes, especially at the beginning, I would be trying to explain everything, and using the best words I knew how. But it was often way too complex, explaining things from my perspective rather than meeting the families where they were at. Midrotation feedback from two of the attendings was really helpful in guiding me about how to state some of the concepts, how to keep it more manageable in terms of what I was saying and then assess for understanding both on rounds and subsequent followup later in the day.
For me this was a growth opportunity that I was able to take advantage of because of feedback from my attendings. This feedback catalyzed my journey in communication in medicine, how I talk to patients and engage with them and their families. You can apply this in any number of situations as you look to connect and catalyze behavior change in your medical practice. It could be smoking cessation, weight loss and healthy habits, or counseling around vaccines. As you look to apply these principles, this leads me to the three things you need to know about communication and behavior change as you approach motivational interviewing with your patients.
First, the three C’s. Caring, connection, and curiosity. Or connect by being curious and caring. So let’s consider a hypothetical patient encounter in clinic, your first patient of the day. It is their first visit at your clinic, and they are kind of quiet. You look over their past history on your intake form and note they have a chronic illness on an immunosuppressive medication. Your staff notes they want to reestablish with a specialist also, but they aren’t interested in further vaccines at this time. You knock on their door and enter to talk with your patient. Hello, I’m Dr. Stegink, nice to meet you, welcome to our clinic. How are you doing today? What brings you in? Where are you from originally? What are your goals for your health? How can I help you? What questions do you have? Making a connection is so important. Asking good questions, drawing your patients in, getting them to share about themselves.
Connecting and caring, building that therapeutic alliance. It can take a lot of time, depending on the responses, but mostly it takes intentionality. Intentionality in how you ask, how you follow up on their responses, what they told you before, asking about their family, what they like, and their goals. All the more reason to prioritize continuity. In an age where access is king, continuity is increasingly under threat. Seeing that family or patient back again and again, you have the opportunity to go deeper, you really know them. They get to see how you really care for them, how you advocate for them, how you continue to push for the things they need.
In my practice, I appreciate my clinic’s broad diversity of patients, from all over the world, from all types of socioeconomic backgrounds. When I meet them for the first time, I ask if this is the first time at our clinic, welcome them, ask whether they have lived in my city for a long time, where they lived previously and often where their family is from. I also speak Spanish and enjoy learning greetings in other languages, and when I am able, I try to learn a few words to greet them at subsequent appointments. The smiles on their faces as I take the time to be curious and learn about them and their background, this is part of connecting and caring.
So first, you have the connection through curiosity and care. Then next, you have to assess your patient’s readiness to change or to engage with something new. Tell me more about your goals around your health. Your new patient shares about how they have been absent from work and family events because of their illness more in the past couple years. They are looking to get that under better control. You meet them where they are at, hearing about their dreams and goals on this particular issue. And yet, you know they are high risk and eligible for their COVID vaccine but as of yet unvaccinated. You ask your patient what they have heard about the COVID vaccine, the different formulations out there. You ask what concerns they may have about it, trying to validate their feelings and talk frankly about the risks and benefits even as you sense their skepticism. You thank them for their honesty about where they are at, even as you advocate for their health and vaccination.
Whether it is COVID vaccination, habit change around activity and nutrition choices, blood pressure management, or something else, there are so many things that we, as physicians, may have particular goals for, even agendas, as we care for our patients. It comes from a desire to help, knowing that next step they ideally need. But if they aren’t ready to make that change, as much as it pains me sometimes, I can’t force them to. They are their own individual, able to make their own choices. Even as I entreat them to make decisions that will help them and be part of the greater good, things consistent with the PUBLIC part of public health, I have to see where they are at, seeking to provide education so they can better consider whether they are ready to take that next step, whether COVID vaccination or otherwise.
So first, the 3 C’s, connection, care, and curiosity. Second, assess their readiness to change. And third, guide your patients to consider their options for behavior change. Sometimes you know pretty early on if this is even going to be a possibility, whether they are ready to consider a change.
Hey doc, I’m looking to lose some weight in the next few months.
Tell me more about that goal. What motivation is behind it? Is there a particular event you are going to soon? Is there a family health problem that you better understand and want to make changes to reduce your risk?
What changes have you consider to work toward that goal? Hear where they are at, what ideas they have, and then you can share some feedback and consider some additional ideas together.
So when your patient comes ready to make a change, that is helpful. But sometimes as you consider different hypothetical scenarios, you realize they may not be ready for all that you know it will take to achieve that goal. After hearing their thoughts, keeping their goals or concerns in mind, you can then, as their physician, share some of the same goals or parallel ones and some of the steps toward that in a way that your patient can understand. Sometimes, I will present a range of choices for that next step, whether it is going for more walks, choosing healthier snack options, monitoring portion sizes. Presenting these options often involves some that might be ideal and some that might be easier to achieve starting out. It may be getting those early wins to help advance their motivation, seeing that, yes, I can make a change and see some results, even if it starts with just growing in discipline.
Part of considering these options together is helping frame the next step in the context of the patient’s stated goal or in some sort of shared priority.
I can tell you really are wanting to care for your health as you came to see me about your chronic condition, and I am so thankful you did. I care about your health, too, and I want to make sure you have all the information you need to make your own decision about the COVID vaccination. Yes, I recommend it, but I also know that I can’t change my patients’ minds about this. I want you to feel heard and that we can have a discussion when there is so much information to consider. I hope this has been helpful as you hopefully consider this more in the future. Thanks for coming in today, I’ll see you at our next visit.
Starting with a caring, curious connection, then assessing readiness to change, and then exploring shared decision making as a means of guiding your patients through some of these decisions. I hope you have seen yourself in some of these scenarios today or that it prompted you to think about particular ones from your own experience.
But reflection isn’t enough. How are you going to take action on this new knowledge? Is it taking that extra time to build the rapport with your patient, asking a curious question to get to know them or how they are thinking about an issue? Is it being more intentional in really assessing whether they are ready to make a change? In the interest of time, I often keep it more brief and jump to a possible solution, “Would this be something you would consider trying?” Or is it giving the patient space to talk and offer up their idea for their next step, even if it means you might end up going with a plan that might be slower for now but maybe gets them on board with their treatment plan in a way that previously wasn’t happening? So…lots of possible applications as you consider your own clinical practice. Just pick one this week and commit to trialing it in your patient encounters, whether in the clinic, on the wards, or your surgical followups, or wherever you see patients.
So imagine if you did this, how do you think this would make a difference a month from now? Maybe you would have patients deciding to try to quit smoking again, going for a walk after work, whatever that step would be where you know it is advancing their health. Not only seeing benefit for your patient, but also for you. Not only does really listening and engaging your patients with motivational interviewing honor your patients as individuals, it also frees you from the pressure of “what if they say NO?” That extra time you spend may be part of their journey toward that healthy habit or that decision to take their next step, but you just didn’t get to see it because you weren’t the final leg of that journey. So reframing your role in that journey can help your own mindset and professional wellness as you have hard conversations.
Thank you so much for joining me here on this episode of The MedEdWell Podcast. Please subscribe and then share this episode with another physician today, and if you haven’t left a review yet, please go ahead and do that in your podcast player. My goal with this podcast is to help other physicians pursue their wellness, personally, professionally, and financially. I need your help to get the word out there. If you are looking for disability insurance, check out today’s sponsor, Pattern, at the link in the show notes for a quote today. Consider how you will grow in your motivational interviewing and take that next step yourself. Please come back and join me on the next episode of The MedEdWell Podcast. Thanks for all you do in caring for patients, and I hope you have a great day!