Motivate and don’t lecture patients, expert urges

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DENVER — How can a pharmacist improve patients’ adherence to their medication therapy and encourage healthier behavior? Don’t lecture, don’t scold and don’t preach. 

That’s the message Bruce Berger, president of Berger Consulting, had for attendees of his insight session on “Medication Adherence and the Role of Motivational Interviewing.” Berger urged pharmacists to think about the way they talk with their patients, to respect their patients’ intelligence and to build a bond of trust in every pharmacist-patient consultation. 

Berger said motivational interviewing, or MI, can help pharmacists bridge gaps in continuity of care and encourage patients to be adherent — even in cases where the patient initially refuses to take a particular medicine or change unhealthy behaviors in the belief that such actions either aren’t needed or won’t make any real difference. The goal, Berger said, is to put patients at ease and enlist them as informed allies in their own health-and-wellness goals.

People are naturally resistant to change if they don’t think that change is necessary — for instance, if they have an asymptomatic condition, such as high blood pressure, Berger said. They also put up barriers to change or adherence if they perceive a threat, even if it’s in the manner or tone of voice in which a pharmacist, physician or other health professional lectures them about their nonadherence, weight gain or other health issue.

“If you’re just telling a patient ‘You are wrong,’ the patient will often react negatively,” Berger admonished. “How you talk to patients can either raise their resistance or ambivalence to a change in their behavior,” he noted, or it can stimulate patients to make better choices for themselves because they were treated with respect and intelligence.

MI accomplishes two things: it develops a high rapport with patients “by honoring their sense-making,” and it “directly addresses the patient’s issues with care, concern and respect,” he added.

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