Dr. Steven Pearce, Dr. Bruce Berger, and I had an inspiring discussion about motivational interviewing. Bruce offered specific and practical suggestions for clinicians to help patients explore their motivation for treatment adherence. Steven responded, “I’m thrilled. I’m sitting here saying I can’t wait for him to give me more examples because I’m going to go use them in about an hour!”

Dr. Steven Pearce is a practicing gastroenterologist and creator of the poignant and beautiful film, Love Evolved, raising awareness about mental health and personal development through sharing his own transformative journey.

Dr. Bruce Berger is a pharmacist who returned to school for a PhD in social and behavioral pharmacy. Bruce introduced motivational interviewing to health care. He shares, “The relationship between the health care professional and the patient is still the best predictor of treatment outcomes!”

During our conversation, Steven offered, “When I first got out of fellowship, I would have patients leave my practice. I was so focused on every single question I had to ask, I’d completely forget that there’s another soul on the other end of that conversation interacting with me.”

Bruce shares this background on motivational interviewing:

Motivational interviewing (MI) is an evidence-based, patient-centered approach to talking with patients who are ambivalent or resistant to health behavior change. MI is a bit of a misnomer because we are not trying to motivate the patient. We are trying to explore patients’ motivations to treat their illnesses. MI is important because it:

1. Sees the patient as an equally valued expert (patients are experts on how they make sense of their illness and treatment).

2. Teaches health care professionals (HCPs) how to attune to and explore:

• How the patient is making sense of their illness and treatment.
• The emotions of the patient.
• What is important to the patient regarding treating their illness.

3. Acknowledges what the patient is doing. Even when a patient takes a daily blood pressure medicine four days a week, using MI, the HCP would first recognize that the patient is taking the medication (“I noticed that you are taking your blood pressure medicine four days a week. That’s a good start toward getting your blood pressure down.”). Then the HCP would explore the patient’s decision (“What has made taking the medicine on those four days important to you?”), followed by, “What would have to change for you to take it every day?”

4. Helps HCPs build relationships that provide a positive lever for change without scolding, fixing, or correcting the patient (which could result in face loss). When patients lose face (“No, the Covid vaccine cannot cause Covid!”), they either stop listening or discount the information provided.

5. Is evidence-based and makes a significant difference in improving adherence to health behaviors and health outcomes.

6. Improves the connection between HCPs and patients. More than anything, MI is about connection. The skills are used to explore ambivalence or resistance with the patient in a way that says, “How you see the world…how you make sense of things is important and valuable to me. I would like to explore those things with you in a way that honors your decisions with the understanding that you ultimately decide.”

This is called the spirit of MI. MI also operates effectively if we understand that we owe the patient everything. They owe us nothing. We are there for them and not the reverse. Ultimately, patients decide whether to treat their illness, lose weight, etc. We can certainly influence that decision through care, concern, and good information. However, trying to motivate, convince, or persuade a patient to do something does not work, especially when a patient is ambivalent or resistant. Persuasion and paternalism force the patient to defend their position. Want to make sure someone doesn’t quit smoking? Spend your time persuading them to quit instead of exploring their desire to quit and what they have tried. If the patient also has a chronic illness, they won’t want to talk with you about that either if they don’t like how you talk with them about their smoking. So, are you willing to open yourself up to really see and understand the patient? Without this understanding, MI is not MI, and real care is compromised.

Steven supported Bruce’s points about MI with the following: “In the travels I did when I was making my film, I spent two years in a course for spiritual psychology, and they did this very interesting practice at the end of every meeting. They called it ‘seeing the loving essence.’

You’d sit there with somebody else in the class and hold hands, and just look at each other eye to eye for a minute.

I brought that back to my practice, where I would see the loving essence of whatever journey the person was on, and how I could be the greatest help to them. It revolutionized how people responded to me; they stopped leaving my practice and they actually liked me!

We get so caught up in having to check every single box that we forget there’s this soul going through something.

I’m fascinated by motivational interviewing because I know there are little nuances that can make such a big difference, and I’m thrilled to learn more of them!”

We hope you are, too.

Steven Pearce is a gastroenterologist. Bruce A. Berger is a health care consultant. Kim Downey is a physician advocate and physical therapist.