A technique called motivational interviewing which was developed in the 1980s and used in substance-abuse and addiction counseling is seeing a resurgence today with doctors helping patients control blood pressure and diabetes, and to start exercising. Rather than telling a patient what to do, and admonish them when they don’t do it, a doctor may ask the patient what changes he or she is willing and able to make – and then support the patients’ confidence and commitment to following through. One goal is to find a solution for patients who aren’t ready to cooperate. Clinicians learn a technique called “roll with resistance” which encourages small steps toward a goal the patient sets. “Many doctors struggle finding the right balance between supporting patient choice and autonomy, and meeting their obligations to make informed recommendations,” says Dr. Ken Resnicow, a University of Michigan health-behavior and education researcher.

Insurers and health systems see the technique helping large populations with chronic illness. Aetna partnered with Dr. Resnicow to train nurses who work as telephone coaches in the technique. Prior to it’s implementation in 2010, “we could identify where an individual was on the continuum to take action but couldn’t really motivate them or help them motivate themselves,” ways Susan Kosman, chief nursing officer. She sees more members agreeing to participate in disease-management programs and dropouts have fallen 55%, she say.

Instead of pushing a person to do something beyond what he or she feels capable of, the technique helps patients set their own minimum goals. The patients know they can exceed their goals at any time, and encourages them to stay committed. According to Dr. Chet Fox, a professor of family medicine at the University of Buffalo in New York, the technique often helps patients set their own more ambitious goals…..    wsj.com     5/1/13

 

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