The acronym “MI” has traditionally meant myocardial infarct, or heart attack. Recently it’s taken on a new, more salubrious meaning: motivational interviewing.
A growing number of docs are practicing this technique, which amounts to listening to patients to help them recognize their internal sources of behavior. Boston’s NPR affiliate, WBUR, describes typical MI interventions in which doctors, instead of demanding that patients stop smoking or drinking or overeating, gently encourage them to get in touch with their reasons for pathogenic behaviors, a process which leaves them more likely to change.
This extends the purpose of medical listening. Usually taking a history is a search for clues to diagnosis. A patient’s narrative contains those clues, to be sure, but is also rich in social content, family stories, folklore, and additional random flotsam which the doctor needs to navigate around. MI offers docs a wider-angle lens. Now, in addition to listening for diagnosis, they can also catch motivational clues which can point a way to effective treatment.
But why stop there? We can use the technique to treat suffering itself.
Having facilitated cancer support groups for more than thirty years, I’ve come to the almost blasphemous conclusion that tumors don’t bother people much. Patients can experience pain, nausea, and other symptoms, but the bulk of their suffering comes from their own emotions. Fear, anxiety, depression, loneliness, confusion, and despair aren’t neurotic reactions, but normal, anticipatable concomitants of serious illness. But these emotions are treatable only if we listen for them.
I routinely ask people with cancer (and family members, too), “What bothers you about your cancer?” Sometimes they initially take offense, but when they realize I’m more sincere than impertinent, they seriously consider the question, and over days or weeks of conversation arrive at answers that become therapeutic.
“What bothers me? Well, it means I’m going to die.”
“What bothers you about dying? No, really.”
This is no easy issue, of course. It can take another week of cogitation.
“I can’t die yet. I have unfinished business.”
“Like?”
“Well, I’m estranged from one of my kids.”
“Do you want to do anything about that?”
This patient has now discovered something she can act on and consequently diminish her suffering.
Of course, this style is a slight expansion of the medical mission. Maybe we docs aren’t restricted to simply diagnosing and treating illness. We can also be in the business of alleviating suffering.
Jeff Kane is a physician and is the author of Healing Healthcare: How Doctors and Patients Can Heal Our Sick System.
