A 46-year-old woman comes to the office for a follow-up visit a week after hospitalization due to a second episode of acute pancreatitis. The patient describes mild epigastric pain that is gradually subsiding. She has no nausea or vomiting. Medical history is significant for type 2 diabetes mellitus, hypertension, and alcohol use disorder. The patient drinks 1 pint of vodka daily. The physician asks the patient, "On a scale of 0 to 5, with 5 as the highest rating, how ready are you right now to make a change in your drinking?" The patient rates her readiness as "about a 2." According to principles of motivational interviewing, which of the following responses by the physician will be the most helpful at this time?

Question

A 46-year-old woman comes to the office for a follow-up visit a week after hospitalization due to a second episode of acute pancreatitis.  The patient describes mild epigastric pain that is gradually subsiding.  She has no nausea or vomiting.  Medical history is significant for type 2 diabetes mellitus, hypertension, and alcohol use disorder.  The patient drinks 1 pint of vodka daily.  The physician asks the patient, "On a scale of 0 to 5, with 5 as the highest rating, how ready are you right now to make a change in your drinking?"  The patient rates her readiness as "about a 2."  According to principles of motivational interviewing, which of the following responses by the physician will be the most helpful at this time?

Quizplus · Accepted Answer

11ec25c8_d7d3_eddb_bc81_fda2840dbf49_MD0003_00 In this encounter, the physician uses a numeric rating scale to explore the patient's perspective on her readiness to change and the reasons for it. This technique is referred to as evoking change talk in motivational interviewing. After asking the patient to assign a numeric value to her level of readiness (eg, "on a scale of 0 to 5, with 5 as the highest"), the physician asks an open-ended question to explore her personal motivations to change. Although this patient reports relatively low readiness (ie, "about a 2"), she does not rate it 0; a good starting point is to help her identify why she rates it 2 (ie, what reasons does she have right now) as opposed to 0. For example, at this point, the patient's reasons for a 2 rating might include a desire to avoid another hospitalization, fear of losing her job, or concern about the effect of her drinking on a relationship. From her perspective, these reasons might outweigh the specific health risks of pancreatitis. In addition to educating the patient about pancreatitis, focusing on her internal motivations is key to promoting change. Evoking the patient's personal reasons for change can help solidify her motivation and prepare her for the planning process. (Choice A) This question focuses on the physician's role, not the patient's. Motivational interviewing seeks to develop the patient's autonomy and self-efficacy in the change process. (Choice B) Although educating the patient about the negative consequences of continued drinking is important, threatening consequences is less helpful than guiding the patient toward identifying her own reasons for change. (Choice D) This question is judgmental; it implies that the patient's rating should be 5 and fails to support her where she currently is in the change process. In addition, it focuses on her deficits instead of her positive reasons to change. (Choice E) Although this statement acknowledges the patient's ambivalence, the physician would miss the opportunity to discuss the reasons that prompted the patient to rate her readiness at 2 and not 0. Educational objective: Evoking change talk is a technique used in motivational interviewing of patients with substance use disorder. The patient is asked to assign a numeric rating to the level of motivation to change; this is followed by an open-ended question to explore the patient's reasons for wanting to make a change. This process can help solidify the patient's motivation and prepare for the planning process. References: Motivational interviewing with alcohol-dependent patients. (http://www.ncbi.nlm.nih.gov/pubmed/28881363)

A 46-Year-Old Woman Comes to the Office for a Follow-Up