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EMSWORLD.com | JULY 2016 39 priorities. We can introduce them to new resources but may be surprised when they turn down options we think would help. The practice of MI is built on the understanding that the patient is the only expert on their life. They are the only ones who can decide whether their quality of life (e.g., being free from gout pain) is more important than its potential quantity (e.g., avoiding premature death from a CHF exacerbation). They are the only ones who can choose which healthy behaviors to adopt or ignore. Our role is not to encourage them to do what we think is best but to help them make the best decision given their priorities in life. Acceptance—Accepting that partnership, and the patient's right to choose their own priorities, means we have to respect the person's autonomy. In fact, Miller describes our new role as requiring a "radical accep- tance recognizing that ultimately whether change happens is each person's own choice, an autonomy that cannot be taken away no matter how much one might wish to at times." Patience will be tested when the patient has a different value system that results in decisions that are illogical to us. CPs will be frustrated when their patient's behav- iors lead directly to their poor health, but they refuse to change. When the patient engages in behaviors we consider immoral, unethical or illegal, we will wrestle with our own ethics and moral compasses. CPs have to understand that although we are trying to help these patients out of a tough spot, they may not choose the same destination we would. It is, however, their inalienable right to choose. Compassion—The Dalai Lama defined compassion as the wish to see others free from suffering. If we accept that definition, then community paramedicine is compas- sion in action. A healthy amount of compas- sion for our patients is critical to the success of our CP interventions and the practice of MI. If we approach the patient with the same clinical detachment taught to our colleagues in medicine, we will likely have a hard time engaging them in the change process. With- out empathy and compassion, our desire to judge our patients will be stronger than our desire to continue to try to help. Evocation—Whether it appears as paren- tal nagging or our boss's micromanagement, offering unsolicited advice seems to be an incredibly common but unwelcome behav- ior when it is directed at you and me. Despite the fact that we largely ignore those who offer us advice, giving advice under the guise of "patient education" is our default inter- vention when we try to help our patients as a CP. Patient education is an important component of CP programs, but one whose value is overestimated. MI is based on the premise that the ideas most likely to succeed are those generated by the patient. Eliciting ideas from the patient is a different skill and role for EMS providers who are used to being problem solvers. Nonetheless, the practice of MI recognizes that the patient is most likely to try and maintain solutions they generate themselves. Understanding these four guiding prin- ciples will help us approach the patient dif- For More Information Circle 30 on Reader Service Card