Clinical Case 1: James
Video: Clinical Case 1: James
Perhaps this scenario is familiar. James is a 33-year-old male with persistent gingivitis. He however is unaware of any oral problems. At his most recent recall appointment it is evident little has changed in his oral hygiene effectiveness. This video contrasts the clinician-centered, advice giving approach to the patient-centered, MI approach discussed previously. In the first segment, the clinician does ask questions, listens and informs; however the tone is much more judgmental and adversarial. The clinician is prescribing or telling the patient what to do. Notice the patient’s non-verbal response to the traditional approach. He looks away and loses eye contact with the provider. Comparatively, in the second segment the clinician again asks questions but the listening is more active with reflection of what the patient has revealed. As the dialog continues, notice the interchange moves between reflective listening – informing - providing options. Also note the increased level of patient engagement, not only in the increased eye contact but also in the duration or amount of time the patient talks during the conversation.
|The patient’s readiness/interest in hearing the information/instruction.||Solicited information or advice in as neutral fashion as possible.||The patient’s reaction to the information/instruction provided.|
|What do you know about how long you should brush?||The data show us that patients do have a natural tendency to overestimate their brushing time.||Could this be true in your case?|
|There is another option that might help you increase your actual brushing time. Would you be interested in hearing about it?||Some electric toothbrushes have a timing device to help ensure you brush for two minutes.||Is that something you think you might like to use at home?|