1. Dancing, not wrestling
How to reach a shared management plan with a patient whom you want to change their behaviour
Maggie Eisner

2. Helping people change behaviour - your experience
Think of a patient whom you tried to help to change
What did you try?
What worked?
What didn’t work?
Any ideas about why it worked/didn’t work?

3. Change Change isn’t a simple discrete event, it’s a process
Sometimes a crisis can precipitate a sudden change
Change usually involves loss as well as the perceived gain
Stages of Change – precontemplation, contemplation, change

4. The cycle of change

5. Our role
Traditional advice-giving isn’t useless but absolutely depends on timing
Need to understand the behaviour’s meaning for the patient - how do they see the benefits and problems of the change?
Help patient prepare for change
Encourage to experiment with small steps
Provide information when the patient is receptive
Accept that people have relapses (and help patient accept this too)

6. Motivational interviewing
A video from the USA

7. Principles We need to enable the patient to Dancing vs wrestling
Believe that change is important
Have confidence in their ability to change
Dancing vs wrestling
Start positive

8. Tools The dinner plate, to choose which behaviour to change first
Scaling questions (1-10 scale)
How important is this change to you?
How confident are you that you can change?
Find out – suggest – find out more (Elicit – Provide – Elicit)
What do they know/want to know?
What do they see as their options?
What might their family and friends think?
What do they think?
Help them set realistic goals/targets which they think will work – concentrate on the next small step

9. Pitfalls (or potholes)
Patients
Helplessness
Agree it’s hard, empathise
Help them recall past successes
Resistance
Summarise what they’ve said (instead of getting into an argument)
Clinicians
Lecturing
Go back to asking questions about the patient’s point of view
Cheerleading
Bring the focus back to the patient

10. Go back to the case you talked about
Can you think of how you might have been more effective?

11. Dance, don’t wrestle … Help patient believe change is important
Help them get confidence they can change
Start positive
Dinner plate
Scaling questions
Find out – suggest – find out more
Help patient set realistic target – what’s the next small step?
If pt helpless, empathise, remind of past success
If pt resistant, summarise what they’ve said
Stop lecturing and get back to pt’s point of view
Stop cheerleading, get back to pt’s point of view

12. After tea – skills practice
Scenarios for groups of 3 (doctor, patient, observer) – preferably
Mixed ST years
People you don’t know well
Patient – study scenario and get deeply into role
Observer – note specific things the doctor did well or could have done better
Feedback – doctor first (How did you think you did? What did you do well? What do you think you would have liked to do better?), then patient, then observer
Feedback should help the doctor – either affirm what they did well, or specific ideas about what they could do differently (Without specific suggestions, you were really good is as unhelpful as you were rubbish)

13. Something to think about over tea
Have you ever wanted to change your behaviour?
What helped/hindered you?