Minimal intervention counselling

Healthy lifestyle choices are fundamental to preventing and treating many chronic conditions and diseases, and require health care professional interventions in many patients. However, even with adequate knowledge, physicians and other health care providers often feel they do not have sufficient time to offer counseling. If advice regarding nutrition, physical activity, smoking cessation, or other lifestyle choices is to be incorporated, it must therefore be short and to the point.

 

In a typical encounter, a GP has 2-4 minutes to play with. However, the relationship within family medicine allows for long term follow-up. Be comfortable repeating yourself endlessly, and stay hoping!

 

Minimal intevention counseling incorporates motivational interviewing, stages of change theory, and the five A's approach to provide brief and focused advice to patients.

 

The University of Wisconsin has built a Medical Nutrition Handbook with tools for counseling in either 5 or 15 minutes, depending on the clinical setting. These tools are built on the 5 A's structure.

 

To check in with patients, ask about the 5 R's:

Relevance

Risks

Rewards

Roadblocks

Repetition

 

Information to Incorporate

 

Limitations of these approaches include:

 

Be a role model (put up pictures of office staff doing things like snowshoeing)

 

Relevance: remind me why you wanted to change

Risks: what are the dangers you face?

Reward: what are the pro's

Roadblocks: what are the barriers and temptations you encounter?

Repetition

 

 

There is a balance: have the positives of change outweigh the negatives

Easier choice, harder behaviour

 

Resources and References

Sclamanna et al, 2000 Arch Int Med