Physician Patient

Motivational Interviewing

This well written article by Rebekah Bernard MD highlights a perplexing dilemma for physicians and patients today. Doctors and other professionals who are denoted as “providers” within a clinic, insurance plan, or government program are graded and paid based on lab tests or questionnaires aggregated as scores for their performance derived from a population of patients who’ve been (arbitrarily) paired with that physician or “provider.”

Yet, we know that in most outpatient settings physicians have little control over what their patients will actually do. The terms “patient adherence” or “patient compliance” attempt to quantify discrepancies between the recommendations of the physician and the actual result of the patient in following his or her advice. Ironically, given the narrow (and narrowing) time crunch for allowable doctor-patient interactions, current P4P methodologies are likely to discourage patients from taking responsibility for their health care.

That’s where motivational interviewing comes in. Motivational interviewing enhances (realistic) patient and doctor decision-making. It helps put “skin in the game” for patients and doctors, especially when both patient and doctor can readily compare real, consequential prices of health care services, medications, and insurance benefits.

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