Do You CAPE?

I am going to mock this article in Medical Economics because that is what I do. In its essence, I always think we physicians can improve how we communicate with patients. My issue is that if the environment is poisoned by metrics and clicks then these recommendations are like pissing in the wind.

The article talks about:

One approach many experts encourage physicians to use is motivational interviewing (MI), a series of techniques to get at the root of patient concerns and help encourage them to make healthy behavior changes.

“At this point in my career, I was quite burnt out,” she says, explaining that her population was quite sick, yet patients continued to keep drinking, smoking, or failing to take their medications. “When I learned motivational interviewing, I changed the way I was with my patients, and as a result my patients changed.”

So how do you do it? Here are two ways:

The concept of OARS offers a snapshot of the skills involved in MI:

O – Open-ended questions
A – Affirmations of the patient’s inner strength
R – Reflective statements
S – Summary statements

and CAPE:

Compassion. The entire interaction is driven by the best interest of the patient.

Acceptance and respecting autonomy. Individuals have the right to change or not change, says Gutnick. “If somebody is not ready, you respect that and you don’t push. You might use some skills to try to guide them toward change, but if you’re hearing a lot of resistance and you have four patients waiting, you don’t push that visit,” she says.

Partnership. The physician is not telling the patient what to do. Instead, “You’re helping the patient move toward change, but you’re equals,” Gutnick says.

Evocation. This means pulling ideas for change out of the patient. “As a doctor, I know a lot of reasons why you should quit smoking, but only you know what’s most important to you,” Gutnick says.

Remember, you first need to do all those clicks to get your payment metrics down. After that you have other problems to deal with because the patients always have more than one complaint. With the last minute you can CAPE or OARS to your heart’s delight. Do you see my point?

I have a realistic mnemonic:

H – hurry the hell up

E – get stuck doing your work every EVENING

L – get out of the system or you will LOSE your mind

P – Pray you will survive a few more years in the job

Can anyone else come up with some so that the ivory tower idiots (academics) can pad their resume? Please share them below.

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