Motivational Interviewing Tips for Community Paramedicine
Helping Patients Overcome Barriers to Better Care
The following tips on motivational interviewing are provided by Mindy Gabriel, a 20-year paramedic with extensive experience in successfully designing and launching Community Paramedicine and Mobile Integrated Healthcare (CP-MIH) programs. Prior to joining HealthCall, Mindy served as the Deputy Chief of EMS Operations for a midwest fire department.
Frequent 911 calls to a residence can be very frustrating. Going to the same address again and again for the same thing for weeks, months, even years can exhaust even the most patient paramedic. As paramedics, we get desensitized to the needs of these callers, and we often think if we just tell them all the things they need to do, they will make the change and stop calling us.
Can you imagine being the patient and your biggest stress is buying cat food for your kitties that you love and you hear someone bark, “if you cleaned up your house, filled your prescriptions and went to the doctor, everything would be all better.” Are we really listening to each other?
On a 911 call, we are trained to control the conversation, get to the outcomes and answers we need…quickly. Do you really think these same communication techniques help understand our patients’ barriers to making changes? Not at all! The key is to take off the 911 medic hat and put on the Community Paramedicine hat by pushing the pause button.
Using evidence-based motivational interviewing techniques is exactly what is needed in order to get connected and better understand what will produce action with your patients. Motivational interviewing is a patient-centric style of talking that focuses more on coaching than instructing the patient what to do and when.
Motivational Interviewing Tips:
- Identify the patient’s personal goals and motivations
- Maintain a positive demeanor
- Practice active listening skills by using paraphrasing and reflective language
- Be empathic
- Emphasize there is no right way to change
- Work as a team
The key is to help patients to understand how they can use their personal goals and motivations to produce positive behavior change. For example, Mrs. Smith lives alone and you go to her residence often on 911 calls that typically result in a refusal. You notice that she struggles to care for herself and often doesn’t fill her prescriptions or go grocery shopping. She appears lonely and is at risk of falling.
On a visit to Mrs. Smith’s home for a lift assist and you can tell that she is getting weaker and could use some physical therapy. She has several cats and you notice she really likes them.
You become frustrated because it seems like she isn’t doing the things she needs to do to care for herself. Your attempts to tell her exactly what she needs to do haven’t worked.
Then, one day you visit her to follow up after a recent 911 call. This time you demonstrate a caring concern for her and realize that she has not been getting her prescriptions filled because she is using her limited income to care for her cats. Mrs. Smith is also afraid to leave her cats alone to go to the hospital or out of the house.
Realizing this is the patient’s main concern, you can now align her motivations with the things she needs to do to care for herself. Once patients realize that you hear them and understand their goals and priorities, a new level of cooperation?? can be achieved as long as your care suggestions align with what they value.
Try these tips the next time you are helping people adopt healthier habits. Starting from their motivations, not yours, can make all the difference in the patient-community medic relationship.