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EMSWORLD.com | JULY 2016 41 To stay engaged in CP pro- grams, patients must trust and respect their CPs. Overlooked, however, may be the fact that the CP must have the same feelings toward the patient to remain interested in helping. When the patient demonstrates feel- ings of entitlement, displays manipulative behaviors or expresses a profound sense of hopelessness, the community para- medic may not trust the patient to have their own self-interest at heart. Observing those feelings and behaviors makes it dif- ficult to want to continue to help and can lead to the CP disengaging from the patient. Conversely, patients who believe the CP's visit is yet another futile interaction with the healthcare system, or who question the CP's motives, or who don't believe the CP is really listening, will also find it difficult to engage in the process. Mutual engagement is essential for the visits to be therapeutic. Just as there as several ways for either party to become disengaged, there are sev- eral things that can be done to help keep the interactions on course. The first is to manage the patient's expectations. An explicit discussion about the types of services you can help with and defining their respon- sibilities in the process can help the patient understand how this may differ from their previous healthcare encounters. Similarly helpful is to do a periodic reas- sessment of the patient's priorities. Patients who appear withdrawn or who have not fol- lowed through on an agreed-upon action may be distracted by the emergence of a new challenge that takes priority. Rather than assuming the patient has lost interest in your help, periodically make sure you are still working on the priority issues. Last, maintaining a sincere positive atti- tude despite the patient's current emotional state can help lift the patient's spirits. While it may seem like a waste of time, spending a few moments during the visit to socialize can help recharge the patient's mood and remind them of how enjoyable life can be despite their current frustrations. Summary Motivational interviewing is both a philoso- phy and a set of communication skills that can help CPs better understand and help their patients. Recognizing that patients have the right to choose their own direction in life and are the best source of ideas for how to change will help the CP avoid trying to solve problems outside of their control. Using open-ended questions, affirmations, ref lections and summary statements can facilitate those discussions and make it less likely that any patient ever tells a CP there is no reason to return. R E F E R E N C E 1. Miller WR, Rollnick S. Motivational Interviewing: Helping People Change, 3rd ed. New York: The Guilford Press, 2013. A B O U T T H E AU T H O R Dan Swayze, DrPH, MBA, MEMS, is the vice president for the Center for Emergency Medicine in Pittsburgh, PA. Dan Swayze FEATURED SPEAKER EMSWorldExpo.com For More Information Circle 31 on Reader Service Card