Carrying our patients’ injuries, pain, suffering is exhausting.
Alternatively, acknowledging their power and ability is invigorating and healing to providers.
Vicarious resilience can help to decrease this impact on us as healers. Putting the focus on our patients' strengths and resilience empowers them to care for themselves, both in this moment and in the future.
I love using the motivational interviewing (MI) approach because it builds a foundation to improve on in upcoming interactions. Each time I make this effort, I’m investing in our future together as my patient trusts me, I understand them better, and we have more tools to keep my patient healthy.
Remember the OARS of motivational interviewing?
Open-ended questions
Affirming
Reflective listening
Summarizing
The affirming section is where we get to highlight our patients’ strengths.
Think about the patient who calls incessantly looking for a same day appointment for something that you see as non-urgent.
Strengths: advocates for self, understands how the system works, uses the system to gain help.
Into an affirmation, this can be, You are someone who is able to use the resources available to advocate for yourself. (*)
Then turn to your patient to help you decrease the barrage on the front staff.
What resources do you think would let you care for yourself without needing to find a way to see me every day? You might learn that they are googling their symptoms and becoming incredibly distressed because EVERYTHING IS CANCER. Pointing them to websites that offer a more balanced approach might be really helpful. Having a nurse who is used to them calling and can answer simple questions may help and referring back to strengths previously noted.
“Building Motivational Interviewing Skills, a practitioner workbook” by David B. Rosengren offers this to help flush out our patients' skills to turn them into affirmations.
For each identified strength, identify how our patient expresses it and how it is helpful. Then write an affirmation using a “you” statement. (e.g. statement * above).
A quick pubmed search of motivational interview results in a large number of hits indicating that MI may be helpful in improving patient compliance with their treatment plans (leaving a good review paper here rather than quoting the hundreds available). The amount of time that could be saved when we don’t have to fix something more than once because our patients aren’t following the plan we thought we’d agreed to….such a happy thought for me.
I tried to find a paper on length of time to use MI in conjunction with our usual interview styles, but can’t find one studying this specifically. The review paper above mentions 15 minutes (oh what luxury!) but also says that repeated attempts were more effective than one brief intervention, which is very reassuring in primary care.
What I did find though, isn’t surprising.
When docs are taught to use MI, they keep it up for a short time, then slip back into their usual techniques unless they are coached to continue.
So what if we slip it into our SOAP notes? Make them SOAAP notes by adding Affirmation to the Assessment. It gives us a moment to pause before determining the plan to incorporate our patient’s strengths into what we do next.
Creating a new “normal” to cue us to look at strengths as part of our interactions with patients helps us to feel better about what has come before by looking at the silver lining, and ensures that we have buy-in from our patients. They will be more likely to follow the plan so we aren’t redoing the same interaction in another 6 months, decreasing our overall workload.
The study that I referenced above estimated a 30% or more improvement in health outcomes (physiologic and psychologic).
Our strength based approach hopefully also role models a new coping skill for our patients to use at home.
And, I guess, for me to use on myself.
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