Medical College of Georgia

 Research and Faculty Development

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Department of Family Medicine
Health Promotion: Counseling Patients

Whether you will be the primary counselor to guide your patients through behavioral change, or use brief interventions (which may be just as
effective), an understanding of some of the basics of motivational interviewing and cognitive/behavioral modification procedures is helpful.

• Express empathy through acceptance of the patient and problem, remembering that acceptance is not the same as approval. Use motivational tools of persuasion and support instead of coercion and arguments.

• Point out any discrepancy between where the patient is now and where patient wants to be.

• Encourage the patient to choose only one or two target behavioral goals to work on at one time to improve chances of success. Don't try to get the patient who is overweight, hypertensive, and smokes to make massive lifestyle changes all at once. However, there may be instances when patients are sufficiently motivated and choose to attempt two behaviors which are related and practiced together.

• Ask patient to identify barriers to change and how they may be addressed.

If other family members smoke, it may more difficult for your patient to quit.

If mom must cook for family, it will be hard to prepare special meals for herself.

If dad's closest friends are his drinking buddies, he will need to change friends.

• Offer specific direction or behavioral advice, use prescriptions, write it down.

Physical activity in sedentary patients has been increased by written activity prescriptions.

Patient Name Mary Smith Date 11/11/99 Address 111 Maple Drive, Augusta, GA Rx: Exercise 30 minutes a day, 5 days a week (Mary Smith's signature) (John Davis' signature) MD No Refill 1 2 3 4 5 DEA No._____________

• Obtain a commitment from the patient.

When writing a behavioral prescription, have the patient sign it like a contract.

• Use positive reinforcement for any efforts, however small.

"I'm glad you are thinking about giving up tobacco. You are wise to do so. Let me know when you are ready, as there are many aids available now."

• Have patient identify ways to self-reward for advances toward goal.

• Understand that it may take many efforts using various resources to motivate some patients. Patience is a virtue.

• Relapse–plan for it. Relapse will happen, but it does not have to be the "end of the world." Discuss this with your patients at the start. Help them find a cognitive framework to deal with mistakes.

• Acknowledge the importance of social support.

• Follow-up by calling or scheduling a follow-up visit to check on the patient's progress.

References

1. Michels, P. (1999) Motivational Interviewing- Stages of Stage. Presentation at Annual Meeting of the Association for the Behavioral Sciences and Medical Education, Savannah, GA.

2. Sloane, P., et al (Eds.) (1998) "Helping Your Patients Stay Healthy" in Essentials of Family Medicine, Third Edition. Baltimore: Williams & Wilkins.

Contact Information

Research and Faculty Development  |  Department of Family Medicine
 Medical College of Georgia

Please email comments, suggestions or questions to:
Stan Sulkowski, ssulkowski@mcg.edu.

January 10, 2008