If offering an opinion and discussing the significance of problems

• Offer your opinion of what is going on and name the condition if possible
• Reveal your rationale for your opinion
• Explain causation, seriousness, expected outcome, short- and long-term consequences
• Elicit your patient’s beliefs, reactions, and concerns
  • Determine if your opinion matches your patient’s thoughts and feelings

‘You’ve told me a lot about this pain in your elbow. I think the problem is tennis elbow … and the reason I think this is because … Does that fit in with what you were thinking? All right, I think the reason why it might have come on now is… and it might give you discomfort for several months. I don’t think it’s serious and I don’t believe this is arthritis as you were initially worried about. What do you think about all this?’

If negotiating a mutual plan of action

• Discuss the options
  • No action, preventative measures, investigations, non-drug treatments (physiotherapy, walking aids, fluids, counselling), medication, surgery, etc.
• Provide information on your proposed management plan
  • Name, steps involved, how it works, benefits/advantages, possible side effects
  • Tailor your explanation to your patient’s understanding and needs
• Obtain your patient’s view
  • Need for action, perceived benefits, barriers, motivation, etc.
• Accept your patient’s views, advocate alternative viewpoints if necessary
• Elicit your patient’s reactions and concerns about the plan including acceptability
• Take your patient’s lifestyle, beliefs, cultural background, and abilities into consideration
• Encourage your patient to be involved in implementing plans, to take responsibility and be self-reliant
• Ask about your patient’s support systems, discuss other supports available

Motivational Interviewing

• Once you understand your patient, you can help them to change their habits. You must have:
  • Knowledge about your patient’s risk factors
  • Awareness and understanding about your patient’s attitude towards the problem
• Briefly, motivational interviewing allows you to foster your patient’s desire to make behavioral changes. Motivational interviewing empowers your patient to take responsibility for their own decisions by increasing their self-esteem and self-efficacy by respecting their views and concerns and by negotiating suitable targets
  • The steps of motivational interviewing are:
    • (1) Discover your patient’s health beliefs
    • (2) Determine your patient’s readiness for change
      • Each stage of change confers a different frame of mind
      • You are more likely to be successful advocating for health behavioral change if your intervention is tailored to your patient’s stage of change

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Exercise: How might you use motivational interviewing to help a patient in the active change stage lose weight through increasing daily exercise? What specifically would you say to them?

If discussing investigations and procedures

• Provide clear information on procedures
  • What to expect, how they will be informed of results, etc.
• Relate procedures/investigations to the treatment plan
  • What value / purpose do they provide
• Encourage questions and discussion of potential anxieties or negative outcomes