Promote healthy behavior with FRAMES technique.(Clinical Rounds)

WASHINGTON -- The key to motivational interviewing is raising a subject without generating resistance, Sam Weir, M.D., explained at the annual meeting of the American College of Preventive Medicine.

"People are more likely to change when there is a discrepancy between their current behavior and their goals," said Dr. Weir of the department of family medicine at the University of North Carolina, Chapel Hill.

Once the physical exam and behavioral assessment is completed, summarize the results of the visit for the patient, and consider adding some motivational interviewing strategies, Dr. Weir suggested.

The FRAMES acronym is a quick and easy way to summarize and address preventive medicine issues, Dr. Weir said:

* Feedback. Feedback means being non-judgmental, and saying with a straight face, "You know Mrs. Jones, drinking a six-pack of beer every night is more than most of my patients drink, and it's more than is recommended for your health." The doctor states a discrepancy in the behavior, compared with what is considered healthy, but makes no judgment. Ideally, the doctor would then ask the patient, "What do you think about that?" But when time is at a premium, move on to the next point.

* Responsibility. Make a statement that reasserts that problematic behavior, and the patient's reaction is up to the patient--for example, "What you do about your drinking is up to you."

* Advice. Doctors who avoid the use of the words "should" and "need," when offering advice are less likely to generate resistance in patients. "I encourage you to consider reducing your drinking" is better; the doctor communicates respect for the patient by the way he or she phrases the advice.