Patients are continually cycling through stages of change: pre-contemplation, contemplation, preparation, action, and maintenance. Whether their goal is to quit using a substance, adhere to a medication schedule, or be active for 30 minutes a day, patients will only move through the stages of changes when they feel motivated. Motivational interviewing is a method with growing popularity in healthcare that can help health professionals recognize where a patient is in this cycle, tailor their communication accordingly, and build patient motivation for change.
A key skill in motivational interviewing is listening for “change talk” and “sustain talk.” Change talk is any speech in favor of change, and sustain talk is any speech in favor of the status quo. Research has shown that change talk can have a self-motivational effect and is an important predictor of change. Sustain talk has the opposite effect. Knowing how to communicate with patients effectively can help health professionals draw out and strengthen change talk, improve the patient relationship, build momentum for change, and ultimately benefit the health of patients.
However, without proper training on how to communicate with patients effectively, a health professional may be missing opportunities for change talk or even promoting sustain talk. Here are five common mistakes that health professionals may be making in their conversations with patients.
1. Complimenting, not affirming
Affirmations are a motivational interviewing technique that has been found to both increase change talk and reduce sustain talk. Affirmations acknowledge a patient’s strengths, efforts, or good intentions. This can increase their confidence in their ability to change.
Compliments, on the other hand, carry a value judgment. Even a positive value judgment can be detrimental to the behavior change process. It can guide a patient towards self-doubt and establish a dynamic where providers approve or disapprove of their actions.
X Compliment: I think it’s really great that you’re planning to quit smoking.
✓ Affirmation: You thought very carefully about quitting smoking and decided you wanted to avoid health complications in the future.
A quick way to avoid compliments is to never start an affirmation with the word “I.”
2. Giving advice, not offering ideas
While patients value the expertise of healthcare professionals, people generally don’t love being told what to do. Giving advice can make patients feel like their provider isn’t interested in their perspective, and it also puts them in a passive role (or worse, provokes sustain talk) when they should be in an active role. Patients are the experts in their own lives and can save time by suggesting the easiest ways for them to change. Often, they don’t need information as much as they need help thinking through their decision to change.
When a patient does need information, it is important for providers to respectfully offer it. One technique for doing this is called elicit-provide-elicit. The first “elicit” is asking the patient if they would like to hear some information or ideas. The next step is “providing” a small amount of information. For the second “elicit,” invite the patient to share their thoughts or reactions. This re-engages the patient and gives them a chance to voice change talk.
X Giving advice: If you don’t lose weight, you’ll be at high risk for diabetes.
✓ Offering ideas: Would it be okay if I shared some information about how weight affects diabetes risk? … What do you make of that?
3. Directing the conversation, not guiding it
Covering everything in a brief patient appointment is a constant challenge. Providers may want to ensure that they cover certain topics during that time. However, the more providers talk and the more they direct the conversation, the fewer chances patients have to give change talk and share their own expertise.
Often, what’s most effective is a partnership where providers frame the conversation and help set the agenda, then give patients space to share their ideas and voice their reasons for change. The provider’s role in this partnership is to listen, encourage change talk, and gently steer the conversation toward behavior change. This approach helps providers make the most of each visit – quickly finding the patient’s key reasons for change and maximizing the time the patient spends building on their motivation and thinking about a change plan.
4. Asking too many questions
Asking questions is an important part of the motivational interviewing process. However, providers should be intentional in the questions they ask and how they ask them. Asking too many questions can lead to the question-answer trap, where the patient falls into a rhythm of waiting for a provider’s questions and then giving a short answer. They might have powerful reasons for change or even ideas for change, but they aren’t voicing them because they’re trying to keep up with all the questions.
There are several ways to avoid the question-answer trap. One of them is to replace multiple closed questions with a smaller number of open-ended questions.
X Closed questions: Did you lose any weight? Were you active for 30 minutes a day? Did you follow the nutrition guidelines?
✓ Open-ended question: Last time you said you wanted to eat better and be more active. How’s that going?
5. Using motivational interviewing techniques, but without empathy
Affirmations, elicit-provide-elicit, and open-ended questions are among the core skills of motivational interviewing. But in practice, these techniques won’t do much to influence a patient’s intrinsic motivation without warmth, engagement, and authenticity. Patients find it empowering to know that someone is listening to them, cares about them, and believes in their ability to change.
Want to know more about how to communicate with patients effectively?
All of these techniques take practice. If you’re interested in learning how to reframe your own conversations with patients or those in your practice, hospital, or healthcare institution, learn more about our role-play simulations in the healthcare space.