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38 JULY 2016 | EMSWORLD.com ing the medication for the gout, as it could cause fluid retention. The patient became irate when he heard the order. He explained that his gout caused severe pain and lim- ited his mobility. He adamantly refused to stop taking the medication. He would rather risk having another CHF attack, he said, than face a life of chronic debilitating pain. The CP tried to explain the man could die if he had another attack of CHF and even offered to talk to the patient's doctor to find a replacement. The patient refused and abruptly ended the call, telling the CP there was no reason for her to return. We use this case to introduce one of the most challenging aspects of commu- nity paramedicine: understanding that the patient has the right to decide their priorities in life, even when those choices could severely limit the quality or quantity of that life. Many healthcare providers assume if they provide education on a disease or describe the risks involved in the patient's behaviors, the patient will make a rational choice and change their ways. If that were true, however, the prevalence of smoking, obesity and sedentary lifestyles in EMS pro- viders would be close to zero. A quick look at your EMS colleagues shows that is not the case. Many of our colleagues know the long-term consequences of their behaviors but choose unhealthy habits regardless. CPs who believe their job is to simply lecture their patients on the errors of their ways will likely find their patients disengaged from the program or frustrating in their lack of progress. While education alone may not be suf- ficient to motivate a change, there are ways we can inf luence the patient's choices. This article will introduce motivational inter- viewing (MI), an evidenced-based thera- peutic communication style that can inf lu- ence the decisions our patients make. Mas- tering these techniques can be challenging for CPs, who must learn to transition from being a quick-thinking problem solver to interacting with patients in a completely different role. The Essence of MI: PACE Yourself By far the hardest part of using MI is try- ing not to solve the patient's problems. In your traditional EMS role, problem solving was a critically important skill. You needed to be able to quickly assess and prioritize the patient's problems and stabilize those you could treat. While you will still assess the patient's problems in the CP role, try- ing to rush your assessment or prioritize their problems could lead you astray. And unlike your role in traditional EMS as the expert problem-solver, the patient is the only expert on what solutions will work for them. To help understand the essence of MI, William Miller (the father of MI) describes four characteristics that help put our new role into perspective. 1 They can be described using the mnemonic PACE. Partnership—In our traditional EMS roles, the patient has a problem, and we offer the solution. However, MI is built on a more equal partnership. Our role is not only to assess patients' problems but to elicit their *For terms and conditions please visit www.buyemp.com/customer-service.html BuyEMP.com You order. We ship (free). * It's that simple. EMPower your savings by joining our Online Loyalty Rewards Program. Join now and receive 250 loyalty points! • Earn points, redeem for $ savings on future orders • Exclusive promotional offers to double & triple your points • First alerts on new product additions to our program • Savings on everyday run items, more additions coming soon! Visit www.BuyEMP.com today to get started! EMPOWER Join Earn Redeem It's that simple For More Information Circle 29 on Reader Service Card