We Know A Lot; What Don’t We Know?

As healthcare providers, we know a lot. We have paid for this knowledge with blood, sweat, and tears–and no small amount of student loans. We’ve read volumes of material, honed our critical competence, mastered abstract concepts, and applied our amassed knowledge through trial and error to countless real-life scenarios.

What do we know? We have information, data, research, and years of patient experience gleaned throughout years of practice. While knowledge and information is critical, what if it isn’t the most relevant change agent for our patients? Think about it for a second: all the knowledge and skill we’ve gathered, memorized, and perfected, isn’t what’s most important.


Let’s look at a real-life example as it relates to smoking cessation.


I met Kate, a public health Nurse Practitioner in Seattle, during an M.I. training. She related a story about how she has been nagging her father to quit smoking for 20 years . She varied her approach: educating him about the grave health risks, cajoling, warning, emailing articles, sharing quit kits, and sending new research.

The data and tools Kate was using were correct and accurate; they were “right.” But being “right” isn’t helpful when negotiating conversations with ambivalent patients.

After learning about M.I., Kate called her dad and apologized. She said, “I know that my nagging wasn’t helpful. I’m learning new ways to support people in their health changes. When it’s important for you, personally, not for me or because of a brochure, please let me know how you want my help.”


She asked him a different question: “How will you know when you’re ready to quit smoking? What will be going on in your life when you know that it’s time to quit?”


Kate shared that her father contemplated that question for days. It nagged him and nagged him inside: the question created a cognitive dissonance. And he ultimately cut down and quit within a few months.

In this case, all of Kate’s articles, knowledge, studies, and judgment were not an effective appeal to her father’s health choices–for two decades. Kate’s knowledge was not a powerful change agent, but this different approach changed her father’s internal dialogue–and ultimately was the most effective smoking cessation catalyst.


What don’t we know? In patient consultations, healthcare professionals can forget that there are two experts in the room: you the professional, and your patient. Your patient has mastered expertise in their own self-care over years of trial and error. Your years of knowledge acquired through data collection, scholarly articles, and academia is ultimately trumped by how a different approach inspires new thinking in your patient, on their own terms.


Try asking your patients a few of the following open-ended questions in the next few days. Activate their expertise and see what happens!

  1. As we’ve been talking about this, what have we left out?
  2. What is the most important part of this for you?
  3. What ideas do you have for getting more exercise, and how might it work for you?
  4. What method of quitting smoking is OFF the table right now, what doesn’t fit for you?
  5. What have you already heard about this medication?
  6. What change would have the most impact on your health this Fall?


For more information on Motivational Interviewing as it applies to your practice, please contact Jonnae to discuss possibilities and scheduling a training today.

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