motivational-interviewing-what-it-is-and-why-you-should-be-using-it-11-638In my last post, Doctor, Judge Thyself, I described how I go to great efforts to help patients make healthy lifestyle changes, and I admitted that I get frustrated and judgmental when met with great resistance.

The post generated significant page views and commentary, which signals to me that it’s worth continuing this conversation!

In all honesty, most of my patient encounters are positive. As long as someone is engaged and maintains even a modicum of a good attitude, I am thrilled. If they want to work with me, I love to work with them.

Even when a patient declares that they don’t want to change a thing, like “I’d rather smoke ’til I’m dead”,  I can walk away without a fight and without stressing about it. I have several patients with whom this type of flat-out refusal is a running joke:

“I know what you’re going to say, doc, and you know what I’m going to say, so why don’t we talk about baseball instead?”

I can laugh and retort with: “Okay, humor me with my little shpiel so I can write that I told you so in the chart.”

It’s only when I am met with the baffling “I want to change, doc, but I just can’t…” that I bang my head against the exam table, and that is what the post was about. It’s the help-seeking-then-rejecting thing. Drives me nuts. I don’t handle those situations well.

One physician, I believe an internist (Jay, please correct me if I am wrong) brought up the motivational interviewing technique, which is very good, and I do use this, though probably not enough, and not very well with the “I can’t”. Dr. Mom (Family practitioner) shared a method I hadn’t heard of that sounds particularly sanity-saving: “Goalification”. The technique is described in a very short, highly enjoyable article by Greg Dubord, MD in Canadian Family Physician:

It’s totally worth taking a few minutes to peruse this, if solely for the entertainment value of the sample encounter. I could see trying this in practice.

Eve Shvidler, an OB/GYN at, commented about the techniques she uses, such as obtaining more details about diet and exercise. I think this is a very good idea, though I often feel like I need more education in nutrition counseling… and more time. At the very least, I need to find better resources for patients.

In the end, there is much food for thought here. I’m always open to hear more… There’s so much pressure on physicians, especially those of us in primary care, to push the masses towards better health. What else can we do… or not do?