Updated: Oct 29, 2021
As we all know, habit change is not easy at the best of times. So when our patients' symptoms are linked to underlying lifestyle causes, how do we help them to see the link, to feel motivated to do something about it and then to change deep seated habits and replace them with helpful habits? In this article, Dr Gemma Newman explores how you can transform your medical consulting by implementing motivational interviewing techniques. Dr Newman has also produced a module on this very topic for our new Lifestyle Medicine Course, Lifestyle Medicine in Clinical Practice.
To create new habits is not easy and requires a great deal of motivation.
Clinicians can facilitate behaviour change for their patients in the consultation.
In order to do this it is worth understanding more about motivational interviewing.
This is covered in Module 2 of 'Lifestyle Medicine in Clinical Practice'
You can use the BLEND-IT model designed by Dr Gemma Newman:
B L E N D - IT stands for
In this article we will look at BELIEVE in more depth
1) We must believe that our patients are capable of change
2) By studying the solid foundation of evidence for lifestyle interventions, clinicians will believe these changes are effective
Dr Newman is a GP and Senior Partner with a specialist interest in holistic health, plant based nutrition and lifestyle medicine. She is regularly involved in medical education for healthcare professionals on Lifestyle medicine and is a founding member and ambassador of Plant Based Health Professionals UK. She is a published author. Checkout her new book here.
Dr Gemma Newman’s insights on Motivational Interviewing in medical consulting
"Being a doctor can be stressful, now more than ever, with constantly changing guidelines, managing expectations and the difficulties of more telephone triage, as well as symptoms as a manifestation of stress. These, coupled with rising administrative duties and increasing mental health issues can seem insurmountable against the backdrop of rising social injustice. In order to facilitate behaviour change, the doctor needs to believe that it is actually possible to implement change within the framework of the 10-minute appointment. Ideally, clinicians would have onsite psychologists, dieticians, nutritionists, health coaches, counsellors, physiotherapists, OT's and health visitors to provide a holistic service and the time each patient needs. But change is possible without them. It is often a combination of interventions that can work with patients; which one to focus on will depend on the person: more exercise, more sleep, less stress, more love, better food. I have created a Motivational Template acronym to use to help you remember how to help your patients create change in their own lives. It can be applied to any interaction where you want to help them change behaviour, and for any specialty. ‘B L E N D I T’ B L E N D stands for BELIEVE, LISTEN, EVOKE, NO BOSSING and DESIRE I T stands for INFORMATION and TIME FRAMES Let's take a deeper dive into the first part of the acronym: Believe BELIEVE Why is belief so important? The clinician should ideally believe that their patient is capable of change, and that the change they are recommending works. Having belief in our patients. The therapeutic relationship with a patient depends on it. The patient is more likely to make a change if they have a therapeutic relationship to lean back on. The relationship clinicians build – even in the first 10 seconds of an interaction – will infuse their consultation with a ‘meaning response’ (like the placebo effect, but arguably more powerful). Belief in lifestyle interventions. What else must the clinician believe in? The intervention they are suggesting. Every day clinicians convince patients to undergo uncomfortable examinations, have blood tests and take medications that have side effects, and we probe their private lives. The clinician must ideally believe there is going to be an ultimate benefit to these things for their patient to be willing to go through it. We can believe in the lifestyle interventions we recommend by seeing the evidence behind them. The evidence for lifestyle interventions for health. Looking at the evidence of lifestyle interventions for health, there is a solid foundational evidence for the benefits of nutrition and exercise, as well as avoidance of known carcinogens such as cigarette smoke and alcohol. The benefits of sleep are now emerging from the neurological research space into the public eye more and more, not only for mood benefits but also for cognition, dementia, and immune health in particular. The role of stress is known, but less researched. The role of self-care practices has much less data behind it, but is still something worth approaching with your patient. To learn more about planetary health diets for the general population, and to help discuss how food choices can help reduce environmental damage, checkout the Planetary Health Diet by the EAT Lancet Commission and the British Dietetic Association’s One Blue Dot Campaign – both of which emphasise the importance of shifting more towards a plant focused diet. The Blue Zones. For nutritional science and long term human health, the most robust evidence to my mind is seeing remarkably consistent patterns at large scale on obvious display. This is demonstrated by the powerful examples of The Blue Zones, those areas of the planet where people have the highest healthy longevity. These have been studied extensively by many teams of researchers, whose work was funded by National institutes of Health and National Geographic. They have a sense of purpose in their day to day lives, stay active throughout life and eat a 95% or more plant based diet."
We hope Gemma's insights have shown how transformational it can be when we review the evidence for lifestyle interventions and recommend these to our patients. This is detailed in more depth on the new course, which also includes more on behaviour change. Both our courses are fully referenced for your ease. Many physicians have fed back to us that not only have lifestyle interventions positively impacted their own health, but also that they have numerous case studies in which lifestyle interventions have helped patients who have only had limited benefit from medication previously. And as Gemma discusses, we also need to have belief that our patients can make these changes. Making changes in my own lifestyle (which is not easy as an intermittent sugar addicted chocoholic!) has helped me believe my patients can do it too. And seeing one patient make impactful changes then helps you to feel confident that the next one can, and the next one.
Are you interested in learning motivational interviewing techniques to apply in your practice?
If so, check out our course 'Lifestyle Medicine in Clinical Practice' with the full module on this topic.
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