stephenrollnick

Hi

I am a community dietitian based in Cardiff and working mostly with chronic disease and weight management.  I was introduced to MI in 2004 and have really embraced it in the last 2 years.  I am observing improved consultations and also improved outcomes.  My problem is this, my most effective consultations are those were the patient shares some very personal information am I afraid that by asking to tape consultations patients will hold back.

I am really keen to receive support from MI Campus, which would involve taping consultations, however I don't want to prevent progress with the patients.  I would be grateful if anyone has any suggestions or ideas they can share fom their practice.

Kind regards

Orla

Dear Orla,

we live in the same city and exchange ideas here on the internet!  I cant see any way around this other than locating a patient you already know perhaps, getting consent to tape,  and reassuring the patient that at the end of the session the two of you will make a decision whether to wipe the tape in case anything personal has come up that they would prefer to keep between you?

Or have I misunderstood you?

kind regards,

Steve

Hi Steve Thanks for taking the time to respond, it is very much appreciated. I know what you mean, it just shows the benefit of this forum. I had not thought about having a longer discussion about the taping and the option to delete it after the consultation, if the patient would prefer. I'll give it a go with a patient I have in mind this week and see what happens. Many thanks Orla

Orla, let us know how you get on!

Steve

Hi Steve

I brought up the subject of taping future consultations with my patient this morning and they were very agreeable.  They said they would be happy to do anything that would help me because I have been so helpful (blow my own trumpet). 

I have a feeling it would be best to bring up the subject of taping after I have met with the patient on a few occasions, when I have gained their trust.  Don't know what you think?

Orla

Dear Orla,

I have come across plenty situations in which practitioners ask patients at the very first consultation about taping.  You obviously need to make sure that you have adhered to good ehtical practice, which I am sure you will (consent form; clarity about exactly who will hear the tape; freedom to wipe the tape if they change their minds, and so on).

let us know how you get on?

Steve

Dear Orla,

I couldnt find your email address.

Well, Ive now had the privilege of meeting you, when you attended our exploratory workshop this week.  Do let Nina Gobat or me know if you want your tapes listened to....... there's a couple of teams in our Department wanting tapes to practice coding on.... but whether you can elicit agreement for this from patients could be a challenge.

Anyway, I had the privilege of listening to a tape you made in the workshop, and just hope that you can continue to develop your skills, feeling as I am like a talent spotter of MI skillfulness, which you have in spades full!  I learned so much from your tape and those of others, a subject I might share on this forum sometime.  How do practitioners establish focus?  Quite a fascinating journey.

All best wishes,

Steve

Hi Steve

Thank-you so much for taking the time out to listen to my tape and to get in touch.  That has to be the ultimate compliment, coming from yourself, so thank-you.  I am also glad to hear I'm not completely off the mark.  The patients respond so positively and I can now say I really enjoy my job, I am commited to continuing to develop my skills.

It would be so helfpul to have feedback on my tapes and once I get the trust's agreement on this I will take you up on your offer.

I have had plenty of practice on agenda setting and mapping over the past 3 days with quite amazing results.  One patient said it was so helpful to have a plan for future appointments together and took a copy of the agenda map to look at before our next meeting.  In addition I have been using affirmations more after listening to your simulations with also amazing responses.  One particular patient who was using sustain talk last week, and I admit I was building myself up to this mornings appointment, responded so differently and was actually using commitment language by the end.  So thank-you to yourself and Nina for such a helpful workshop.

I will let you'se know how finding focus goes.

All the best

Orla

Dear Orla,

Those experiences you are having with agenda mapping are of great interest to Nina and I.  She and I share a clinical intuition that the focus or direction of consultations about change is often blurred, circular and unhelpful. We also feel that there must be naturally good practice out there, without any reference to MI, and some of the tapes we gathered during that recent workshop, before we got into MI, confirm this. Good practice exists, with skills yet to be unearthed.

If you are finding that agenda mapping is helpful, any tapes you gather will be like gold dust for us. Moreover, what about your reflections? Single paragraphs, like a log, that describe your brief reflections after a consultation?  if you are inclined, why not gather them, perhaps without any personal client details revealed?

Fascinating. Thank you so much.

Steve

Hi Steve

Yes, I agree with you about discussions about change being unhelpful and circular and most colleagues in my profession will also voice this. 

I have been practising again in clinics this week with really positive results.  For some follow-up patients, even asking towards the end of the appointment what would be helpful to focus on at our next meeting they have been coming up with specific ideas which is really helpful.

There have been three patients this week who have had multiple health problems and the process of agenda mapping has helped both of us to see where they want to focus and also the links between the other struggles in their life and eating behaviour and weight.  It certainly makes me feel more focused.

I will reflect on these three particular patients and e-mail them to Nina, if that is ok?

Many thanks again

Orla