We have learn how to talk with (NOT TO) patients

Digital health and telehealth are upon us. I can assure you that we will invest in the technology and expertise to advance these important areas. BUT, will we invest in the necessary skills to know how to talk with (NOT TO) patients and appropriately negotiate patient-centered care? Maybe a better question is will health care (including and especially schools of medicine, nursing and pharmacy) finally invest in training health care professionals on how to effectively talk with patients about health behavior change?

Last year we spent over $500 billion on nonadherence to medication regimens. That does not include nonadherence to needed life style changes. The rate of nonadherence has not changed in 40 years! You have to ask why? Generally speaking, schools of medicine, nursing and pharmacy do not spend adequate time training HCPS on HOW TO TALK WITH patients about health behavior change.

And we don't adequately assess how the patient makes sense of their illness or treatment. For example, asking a patient with diabetes, "What does diabetes mean to you?", "How important is it to you to get your diabetes under control?", "What's your understanding of the importance of taking the medicine to treat your diabetes?", "What's your understanding of the role of lifestyle changes to treat your diabetes?" The answers to these questions will illuminate what education is needed, potential adherence problems, and overall, how the patient is making sense of their illness and treatment.  After learning these things from the patient, we have to know how to respond in a way that is non-threatening and supportive of the patient, while getting misinformation and gaps in understanding corrected.  That takes training. It is absolutely vital! 

So, it's not either digital health or talking with patients...expertise in both are vital.  When dowloaded data from a device tells us the patient is not using their chronic inhaler as prescribed, we have to know how to intervene in a way that is non-threatening and explores the reasons for nonadherence without sounding critical.  We have to explore why the inhaler is being used at times and not at other times. This has to be done by supporting what the patient IS do and exploring their reasons for any success, but also exploring what's keeping them from using the medication as prescribed. And, all of this has to be done without sounding like a prosecuting attorney. When patients feel criticized or corrected they lose face and either stop listening or discount what is being said. And it harms the relationship. Healthy and productive relationships with patients are the essential leverage needed to positively influence health behavior change. Learning the skills to create heathy relationships with patients and explore adherence to health behaviors takes an investment in time.

William Miller, the developer of motivational interviewing (MI), conducted research demonstrating that between 8 and 24 hours of guided training are needed to achieve competence in MI. When are we going to make the same investment in teaching these vital interpersonal skills that we make in technology or teaching about diagnosis, how drugs work, review of systems, etc.? The evidence is that we are not making this investment. I hope this changes. It is badly needed.

Want to learn more? Visit mihcp.com or https://tinyurl.com/PurdueCE-MI-HCP