The Transformative Potential of Motivational Interviewing in Primary Care

I recently read a white paper that mentioned motivational interviewing as a useful tool in integrating mental health with traditional primary care.  Motivational interviewing first came onto the scene 50 years ago in the counseling world as a tool to help people change their behaviors so they could achieve their goals. In that respect, if we translated it to the medical context, we’d think of it as extremely patient-focused.

However, an example provided in the article made me wonder whether, in the author’s practice, the role of motivational interviewing is to have the patient’s goals and priorities inform the treatment plan or whether it is used as a technique to help clinicians “sell” their treatment plan to the patient. 

As we contemplate the question, it’s a good time to reflect on our own understanding of the intent and power of motivational interviewing.  It is also an opportunity to take stock of how our clinical teams and models incorporate motivational interviewing into the patient journey.

Here are a few questions to guide your exploration:

• Who in your organization is trained in motivational interviewing? Are the physicians who are designing treatment plans using the technique or only those who do initial assessments or case management?

• Is motivational interviewing infused into every key interaction with patients or only once in the process of initially assessing a patient?

• As you read patient charts, can you see the deep connection between patients’ answers to questions about what matters most to them and the treatment they are prescribed?

• If you are a clinician, reflect on your own motivations in using motivational interviewing techniques?  Are you still as curious and authentic in your exploration of patient goals and beliefs as you were when you first began?  Or are you using the techniques as a means to an end – to achieve your goals and performance measures rather than those of your patient?

Physicians are fulfilled by using their deep clinical knowledge, skill, and authority to help people live their best lives. When done well, motivational interviewing helps clinicians make deep connections with their patients. It builds trust and invitation to convey their wishes, worries and hopes for them.  Just by asking the right questions, in the right way, with the right intent, physicians let their patients know “I hear you. I see you. And I know what you want and why you want it. That is guiding me as I design your treatment plan because I am moved by what you want, so much so that I want it for you too.”

It’s important to add that even though this approach helps patients, it’s also tremendously restorative for clinicians, who time and again report that motivational interviewing, when done right, enables them to practice medicine the way they’d always wanted – namely, in close connection to patients.

So for every senior out there, or every family member who is helping a senior manage their health, I’d urge you to bear this in mind as you engage with your physician. Think about the life activities that really matter to you, and the bucket list items that are still within reach or maybe would be within reach if you could just stretch a little. Bring them up early on at your next visit and talk about the elements of your treatment plan that speak to those goals.

For my fellow healthcare leaders, consider motivational interviewing an instrument to help your organization achieve the quadruple aim, solving problems the way and in the order patients want to solve them and in the process, helping clinicians find meaning in their practice and in the work of the organization.