Let’s say you’re a physician with a patient who has shared with you his struggle with alcohol addiction. At today’s early morning appointment, he says that he only drank four beers at breakfast, instead of his usual eight. Your response?
How you answer might be very different after a motivational interviewing class with Russell Spieth, an adjunct instructor of family and community medicine.
“When people are engaging in behaviors like drug or alcohol use, not taking their prescriptions as prescribed or non-suicidal self-injurious behaviors, they can come in feeling fairly shameful about themselves. I’m in recovery, too, and I’m accustomed to adversarial encounters. You can disarm people by engaging and empathizing with them,’’ says Spieth, who holds a Ph.D. in counseling psychology.
Through role-playing to simulate the situations they might encounter, Dr. Spieth coaches fourth-year College of Medicine students in a capstone course. At a recent class, he took the role of one patient after another for the students, effortlessly segueing from a person struggling to change their diet to another who wanted to stop using heroin or another who was apprehensive about having surgery. The students practiced their responses in the safe space of a classroom with their instructor’s always-encouraging feedback on where to pause, when to ask more—and what to ask.
With a patient who knows he drinks too much but is having trouble stopping, Dr. Spieth recommends a question that might first seem counterintuitive: “What do you like about drinking?”
Letting the person be heard is the first step toward examining what motivates them—and what might motivate them to change, says Dr. Spieth. With empathy and affirmative comments, the physician can gain trust and partner with the patient to help them find solutions. Dr. Spieth recommends taking the time to get to know the patient’s situation first, and to ask questions like, “How would you like me to help you?” rather than making assumptions about the patient’s priorities or needs.
Helping others find answers
It’s not always easy, says Dr. Spieth, who previously spent years working at Housing First, a program to alleviate homelessness. When he saw one client with a drinking problem wash down a vitamin with a big swig of high-alcohol Steel Reserve beer, it took everything he had to say, “You’re taking a step toward health today,’’ but he recognized that the client was making an important move in a better direction.
Dr. Spieth has been a counselor at the University of Akron Counseling and Testing Center since 2016. In addition to teaching NEOMED students, this spring Dr. Spieth is also teaching primary care physicians via Project ECHO-NEOMED: Ohio Alliance to learn about Medication-Assisted Treatment (MAT) for addiction.
Teaching NEOMED students is incredibly rewarding, says Dr. Spieth, “because of their passion for delivering high quality health care, their desire to be compassionate and empathetic, and their willingness to be open-minded about patient care.’’