OVERALL RATING Good
STRENGTHS Presents both theoretical and pragmatic strategies of motivational interviewing
WEAKNESSES None
AUDIENCE Academic family physicians, physicians with interest in behavioural change
I’ll admit that I’m a champion of motivational interviewing (MI); as such, an opportunity to read how MI might assist me in both my practice and my teaching of family medicine residents and medical students piques my interest.
This book is helpful and practical in guiding readers through the concept of MI and how it changes the ways we interact with our patients about the most difficult of issues, especially behavioural (and lifestyle) change.
The authors call the principles of MI (eg, honouring patient autonomy, collaborative interaction, and the evocativeness of patients’ strengths and abilities) the overarching “spirit” of MI. This seems to fit right in with the philosophy of family medicine.
Using a mnemonic (RULE), the authors describe the important rules of MI, highlighting the great paradox of how what we are trying to achieve with our patients with our present strategies mostly backfires. The RULE mnemonic is easy to remember: Resist the righting reflex. (Correcting or offering alternatives rather than providing guidance to patients is a common flaw that I’m certainly guilty of.) Understand the patient’s motivations. Listen to your patient. Empower your patient.
If these principles and rules of engagement with patients fit your frame of reference, then you will find this book to be useful and challenging. The bulk of the book helps you use the RULEs by explaining how interviews can help you engage with patients differently than you do now; however, this is more challenging than it seems.
I tried this in my daily practice and it hurt. Why? Perhaps because my ways of working have substantial inertia and are difficult to change. I found it easier to coach my residents in using these techniques, as I could provide the insight on how to motivate by using this model when conducting interviews.
What are the results of my own experiment of incorporating these MI strategies into my day-to-day work? I have less frustration with those who aren’t planning to change; more frustration with those who are contemplating change but are still full of ambivalence; and lots of new insights about my role as a “coach” rather than an expert advisor in my work with my patients.
I presented the concept of this book to a panel discussion with physicians and nurses on motivating obese patients. The book’s concept enabled me to provide the forum with a practical and honest perspective about both the struggles and opportunities that MI presents as we search for effective strategies to motivate our patients toward healthier lifestyles.
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