Ok -so it only took me 40 min to post the first one so this posting will get better.

This session was about motivational interviewing and was led by Julie Childers and Bob Arnold. We were very interactive and engaged and it was very heartwarming to see a large roomful of colleagues who have really good communication skills but want to think critically about how to get better. One of the things this meeting regularly provides is that warming of the heart.

Specifics:

Techniques- we reviewed standard interviewing to prescribe change, and the spirit of motivational interviewing: curiosity, respect for autonomy, patient as expert, physician as consultant, collaboration and empathy. The OARS of motivation interviewing were described: O- open ended questions, A-Affirmations R –reflections and summaries.

The difference between following up with a question, or following up with a reflection was stressed .The reflection can add a little more of your assumption about what was said, and can advance the conversation, so it is a good technique to understand.

And then we practiced, and by reflecting had a really insightful discussion of creative outlets and how they relate to palliative care practice in a small group in a very short time.

I do agree with the comment made in the session that reflecting creates more vulnerability for you as an interviewer, but also for the patient. In practice the art is as always to balance reflection with questions or summaries, or silence.

In the discussion, issues of “agenda “and right and wrong” in meetings with patients and families and concerns were described. I think all of us have thought about and about the idea that in palliative care there is no right answer for a given patient or family , there are their answers which we may not agree with. If we find continued disagreement our job should be to find out why the patient/family is choosing the option they are and provide support.

Again valuable to add another frame to think about how we communicate, and how to teach this to others.