Last week, I took a class on “Motivational Interviewing”.  It has nothing to do with people sitting down and sharing pompous views of themselves.   Motivational Interviewing, as I understand it, is to help promote change in people who are still on the fence regarding whether or not they really want to change.

For the medical profession, this is an interesting idea. Normally, we sit people down, the person states their problem and after they talk for 15 seconds, we interrupt, tell them what the answer is, advise a few home remedies, give a few prescriptions, and tell them to do exactly what we told them (ok, so maybe it’s not exactly like this but…).  This works to create change in someone about 10% of the time (I made that number up so it may not be true).  People don’t generally need more information about how smoking will give them lung cancer in order to finally make the plunge and just quit.  In the same way, I know I should exercise and eat right and yet, with Cinnamon Rolls in the refrigerator, next to the carrots, I still choose the Cinnamon Rolls.  Do I know better?  Yes.  And yet change still evades me.

Motivational Interviewing is a way of listening and drawing out from the person their viewpoint, the changes they want to make, the way they will make them, with only guiding the conversation with open ended questions, affirmation, reflections, and certain strategies.  It’s quite interesting really.

I am probably not explaining this very well…you can Google it.

So, last week, I had a patient come in to talk about Diabetes.  I had talked to him 2 weeks prior and we had talked about how he could swim more and eat less fatty food.  When he came in for follow up to talk about diabetes, the first thing out of his mouth was how he is not sleeping well.  He went on and on.  Finally, I interrupted him so we could talk about exercise and diet.  We talked a little bit about this but it came full circle back to his sleep issues.  Guess what?  Blood sugar does go up if you aren’t sleeping well but besides that-This man is not going to change anything until we help him with his number one issue-Sleeping difficulties.  My talk about exercise and diet was useless because I just wanted to talk and didn’t address the first thing out of his mouth.

People talk about what’s most important to them FIRST.  I think we would learn a lot from people if we would just listen actively, reflecting back what the person has said, in different words, or reading between the lines, and telling the person, “So, in essence what you are saying is…. and it sounds like you really value blah blah blah”.  In order to say this, I have to listen.  I realized, after taking the class on MI, that I don’t listen very well if at all.  Seriously.  I am really too busy thinking about what I am going to say next to listen well enough to reflect back to you what you are saying and meaning.  I have become a pro at acting like I am listening and giving proper general responses, smiling and nodding.  People have told me many times what a great listener I am.  Well, if the definition of listening is just not talking then, yes, I am a great listener.

The reason I don’t want to listen?  I don’t want to care. And by caring, I mean to really get into the nuances of people’s lives-the nitty gritty stuff-to offer support, care, concern, sympathy, empathy (And I am not sure the differences between those last two words but I think both should be in this list of defining the term “care”)

If I don’t listen, then I am ignorant. If I am ignorant, I don’t have to take responsibility.  It’s easier.  It’s selfish.

There is a way to listen and not take on that person’s burden as your own.  But I haven’t learned how to do that yet.  I don’t know how to care a lot and not become overwhelmed so I choose not to care as much as I could.  If I don’t care then I can forget about you for the rest of the evening or the weekend.  If I don’t care about you, then I won’t cry.  Then I won’t have to call you.  Then I won’t have to give you money.

Granted, I do care about people.  I do care about you.  I can listen and I generally do but…I just don’t listen as well as I could…and I have a feeling, you don’t either. 🙂

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