All I can hear are Doctors moaning and arguing with Patients because they don’t have enough information to know how to motivate them

…(8min) families are taught how to communicate with their loved one, instead of confronting them about their addiction they’re taught a communication strategy called motivational interviewing that I’m going to talk a little about with you. so Jen’s mum wanted to motivate her enough to go into treatment right and perhaps you’re thinking of someone you’d like to motivate so follow along. We taught Jen’s mum to ask Jen ‘imagine we asked you to just see an addiction specialist for one session, how ready might you be to do that?’ and we instructed Jen’s mum to ask on a scale of 1-10 where 1 is ‘not ready at all’ and 10 is ‘totally ready’. Now Jen was kind of angry right about the intervention, about what happened, but she also knows she’s in big trouble so Jen said “a three”. Now what would you all want to say if your daughter said “on a scale of 1-10 I’m a 3 for going to just one session”? “Are you kidding! Just a 3! You were found on the side of the road you could’ve been killed! Why not a 10?”. What would Jen say if we asked her that? She’d throw every rationalisation in the book at her mum “oh it wasn’t that bad and it never happened before, I can stop at any time”. That simply doesn’t motivate people, I know it’s very satisfying to ask people why they’re not more motivated but it doesn’t work. So instead we trained her to ask “Hey that’s a 3 that’s 30% there. Why didn’t you say a lower number?” Yes you heard me a lower number, so we caught Jen’s attention now and she’s being encouraged to ask why she has any motivation at all. The question is why didn’t you pick a lower number but what Jen said was the beginning of her motivation to change. it was the beginning of her recovery. She said “well sometimes I just can’t keep myself from overdoing it and the next day I regret doing stuff that I did the night before”…

…(​13:30)​ one day when I got to work I saw many of our staff standing in front of the entrance of the Hospital, so I go over to my Unit Chief and I say “what’s going on?” and he says “look up there! That’s your Patient on the ledge of that building threatening to jump”. My heart started pounding: I said “what should I do? who should I talk to?” and I still get chills when I talk about it to this day. He looked me dead in the eye and said “ah don’t worry about it, he’s not going to jump. Just go to the ER and start working up our Patients”. Could you imagine? I was in shock so I go to . and went to the ER but on that day I could only hear Doctors and Patients arguing, above the moans and the groans of pain in the ER Doctors were saying “why didn’t you take your medication?”, “what’s wrong with you – you’re going to die?” Patients countering (with) “you don’t know me how can you talk to me like that?”, “I don’t need that medication”… it was then that I had another moment of impact. I had been speaking to the poor man on that ledge in much the same way several weeks earlier, it was right then and there that I realised we needed to change the way that we spoke to Patients if we were ever going to have a chance of motivating them to change

I found this TEDxYale talk by Michael V Pantalon on the need for us to use scientifically-supported treatments to help Patients and their families who are affected by addictions to be very revealing.

It’s key to appreciate that very few/any healthcare systems in the world properly resource addiction treatment services because most still treat drug abuse as a criminal activity. Another issue is that much of the funding that is available gets funnelled into the pockets of giant pharmaceutical companies who have people who have studied the science of motivation and can commit huge marketing budgets advertising (AKA “publishing papers in scientific journals“) to Clinicians so that they are convinced that they are protecting their backsides by prescribing branded medications.

Thanks to the amazing Doctors I get to work with I don’t have a heart that waits until I see a Patient standing on the edge of a building before it starts to pound. My heart pounds when I see Clinicians failing to use the tools of our timethat’s one of the reasons why you’ll notice that at the drop of a hat I do odd things like fly off to another continent to provide the mHealth for Healthcare Professionals CPD accredited course.

Because so many Doctors think there’s no time/resources to take and document a proper history we have a situation where moaning at Patients is the norm eg. “it was almost like a needle dropping on a record“, “the Doctor reviews a little booklet with all the numbers and he gets a breeze on his face as he is moving through them“, etc.

The scientific evidence is there, it says:

> One of the most caring things you can do is provide your Patient with a way to contact you
> Patients answer questions asked of them by computers more honestly than in person
> Clinicians can better serve Patient needs when they have the ability to learn about them before they present in their office
> We can care better for people if we let them tell us about the issues they need help with.

Why don’t we just use motivational interviewing on Doctors?

The solution seems obvious why don’t we simply show Doctors the evidence and then ask them how motivated on a scale of 1-10 they are to provide better documented consultations together with clinically validated ways by which Patients can communicate with them before or instead of visiting them in their office.

The beginning of change is when Doctors examine what it means to say “It’s always been done this way” and realise the 2000 year old healthcare model is broken and the energy they spend stressing over change is wasted.

About David Doherty
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