The Effective Physician: Motivational Interviewing Demonstration

>> Watch what happens this time when the provider cues

into what the parent is saying, empathizes with her situation,

and attempts to work with the parent

to find a solution that fits her needs:

>> So I wrote a prescription for antibiotics for Aiden.

>> Okay.

>> I did want to talk to you though;

I'm a little bit concerned looking through his chart

at how many ear infections he's had recently.

And I noticed that you had checked the box

that someone's smoking in the home.

So I was wondering if you can tell me a little more

about that?

>> Well, um, it's just me and him and I do smoke.

Um, I try really hard not to smoke around him.

But I -- I've been smoking for 10 years except

when I was pregnant with him.

But everything is so stressful being a single mom

and having a full-time job.

So it's just, that's why I started smoking again.

>> You have a lot of things going on and smoking is kind

of a way to relax and destress.

>> Yes. Yeah, some people have a glass

of wine, I have a cigarette.

>> Sure, and it sounds

like you're trying not to smoke around him.

Why'd you make that decision?

>> I know it's not good for him.

I mean I've read those things about ear infections and asthma

and stuff and -- but other kids have ear infections

and their parents don't smoke.

>> So on the one hand you're worried

about how your smoking might be affecting him

and on the other hand you're not so sure

if it's really the smoking that's causing these problems.

>> Right, yeah.

I mean he doesn't have asthma.

He -- I don't -- he hasn't had a lot of other problems

that his other friends have.

So and I've thought about quitting before in the past

but I just don't see how it's possible right now.

>> What made you decide to quit smoking when you were pregnant?

>> Well, he was inside me and we were sharing everything

and I knew that he would get some of that and I didn't --

I just didn't think I could live with myself

if something happened to him.

>> Right now, though, it feels almost too difficult

to manage or even to try.

>> Yeah, exactly.

>> How were you successful when you quit before?

>> I don't know, I think

about it now I don't even know how I did it.

I just did it.

You know, I just couldn't imagine like him not being born

or going into labor early

and him having problems and stuff like that.

All the stuff that they talk about with women who smoke.

So that was just enough to say okay, you know what?

I'm not going to risk that.

So --

>> The risks were so scary then that you were able to stop.

>> Yeah.

>> But they don't feel as scary to you now.

>> No, I mean we're two separate people

and like I said I don't --

I try really hard not to smoke around him.

I'm pretty good about that.

I don't let other people smoke around him, so you know.

>> You're doing the best you can do.

>> Yes. Yeah.

>> Okay. But it sounds to me, too,

like part of you really does want to quit.

>> Yeah, I know that I need to and I -- you know I keep,

every New Year I say this year I'm going quit smoking.

But then something happens and it just doesn't --

quitting just doesn't happen.

>> It's on your to do list, it's just not making it to the top.

>> Yeah.

>> If you did decide to quit, on a scale of one to 10

where one is not

at all confident you don't think you could do it

and 10 is you feel pretty certain that you could,

where do you think you fall right now?

>> Probably like a 5, kind of in the unsure area.

Like, I know I've done it before so I know I can do it,

but at the same time it just seems really hard,

and it's not the same situation.

>> Sure. Well what made you say 5 rather than 2 or 3?

>> I know all the ways it's bad for me and I don't want him

to grow up thinking that it's okay to smoke.

I don't want him to use any kind -- I don't want him to chew

or anything like that.

So I know I need to, especially before he gets old enough

to understand what mommy's doing,

but I just don't know if I can do it.

>> Okay. So it sounds like you have a lot

of reasons why you'd like to quit.

You have been successful quitting in the past,

and right now you're just feeling a little bit hesitant

about your ability to do it.

>> Yeah.

>> Where do you think we should go from here?

>> I don't know.

I'd like some help.

I just don't know what kind of help I need.

>> Sure, well if you'd be interested that's something I

can definitely talk to you about.

There are a lot of new options

that can actually help people be way more successful

in their attempt at quitting.

There's different medications you can try.

>> I don't like medicine.

>> Okay. There's also a lot of support groups and classes

that you can take where you have other people

to go through it with you.

Sometimes just having that support can be a big part of it,

especially for people like you where smoking is

such a stress reliever.

>> That sounds nice, but I'm not sure

if I have the time for all that.

>> Sure, it feels like something that would take up a lot of time

and maybe not fit into your life.

I wonder if we could talk about some options

that might fit into your life?

>> That would be really nice.

>> Okay. Well if you're willing, then we could set

up another appointment where you could come in

and we could talk more about that.

>> I would like that.

That would be great.

>> Great.

>> Thank you.

>> Sure.

>> This time, the provider had the same agenda to talk

to this parent about the dangers of secondhand smoke,

and to counsel her to quit smoking.

However, this time the provider's focus was

on the parent's own view of the issue.

By giving the parent an opportunity to reflect

on her situation, the provider was able to elicit reasons

for change from the parent herself.

There was no need to lecture or scold

because the parent was making her own case against smoking.

Many times, our patients already have the information

that we try to give them.

What they really need is someone to listen to them

and to help them sort out a plan that will fit in their life.

By accepting and respecting our patients,

even with their faults, we communicate our genuine desire

to help them make positive changes in their lives.

During this interaction, the provider demonstrated

that she understood the parent's struggle

and that she still wanted to help.

As a result, this single parent found she finally had someone

on her team.

This increased both her interest and willingness

to try working further with the provider to find a solution

that would fit in her life.

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