title: Important medical decisions: Using brief motivational interviewing to enhance patients' autonomous decision-making.
abstract: OBJECTIVE
  The use of motivational interviewing (MI) when the goals of patient and physician are not aligned is examined. A clinical example is presented of a patient who, partly due to anxiety and fear, wants to opt out of further evaluation of his hematuria while the physician believes that the patient must follow up on the finding of hematuria.
  
  
  BACKGROUND
  As patients struggle in making decisions about their medical care, physician interactions can become strained and medical care may become compromised. Physicians sometimes rely on their authority within the doctor-patient relationship to assist patients in making decisions. These methods may be ineffective when there is a conflict in motivations or goals, such as with patient ambivalence and resistance. Furthermore, the values of patient autonomy may conflict with the values of beneficence.
  
  
  METHODS
  A patient simulation exercise is used to demonstrate the value of MI in addressing the motivations of a medical patient when autonomy is difficult to realize because of a high level of resistance to change due to fear.
  
  
  CONCLUSIONS
  The salience of MI in supporting the value of patient autonomy without giving up the value of beneficence is discussed by providing a method of evaluating the patient's best interests by psychotherapeutically addressing his anxious, fear-based ambivalence.
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Michael V
authors.initials: MV
authors.lastname: Pantalon
authors.forename: William H
authors.initials: WH
authors.lastname: Sledge
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Bauer
authors.forename: Beth
authors.initials: B
authors.lastname: Brodsky
authors.forename: Stephanie
authors.initials: S
authors.lastname: Giannandrea
authors.forename: Jerald
authors.initials: J
authors.lastname: Kay
authors.forename: Susan G
authors.initials: SG
authors.lastname: Lazar
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Mellman
authors.forename: William C
authors.initials: WC
authors.lastname: Offenkrantz
authors.forename: John
authors.initials: J
authors.lastname: Oldham
authors.forename: Eric M
authors.initials: EM
authors.lastname: Plakun
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Rockland
mesh_terms: D026686:Beneficence; D003144:Communication Barriers; D003657:Decision Making / Q000941:ethics*; D037001:Directive Counseling; D004992:Ethics, Medical / Q000193:education; D005239:Fear / Q000523:psychology*; D006801:Humans; D009042:Motivation; D062405:Motivational Interviewing / Q000379:methods*; D010349:Patient Compliance / Q000523:psychology*; D010358:Patient Participation / Q000523:psychology*; D016544:Patient Simulation; D010817:Physician-Patient Relations