Often parents will be angry or upset around the topic, he said. “When you have a parent whose child is overweight or obese, it’s not like you’re the first person who ever brought this up.”
To apply the technique with an overweight child, Dr. Resnicow said, you might ask that child to tell you all the reasons working against making changes — which foods do you like, which foods do you hate — and then think about possible small changes and realistic goals.
The clinician then practices what is called reflective listening, responding to what the patient explains, restating what you’ve heard. With a parent, Dr. Faith said, you might explore the core values of how that parent wants to behave and care for the child. There should be no conflict, she said, and “no confronting whatsoever.” Instead, providers are trained to use different types of reflections to help patients think more deeply about what they value and what they want. And ultimately, the doctor and the patient create change plans for the patient to take home.
Dr. Wasserman said that he had found it liberating to realize, “it wasn’t my job as a physician to change anybody’s behavior.” Using this technique, he said, gives the clinician a different and even more challenging job: “Create the circumstances to allow people — and for pediatricians that’s usually parents — to reflect on the discrepancy between what their values are and what they’re doing.”
For example, Dr. Faith said, the mother of a toddler might be feeding the child juice and sweetened cereals. “Culturally, she feels like feeding is part of mothering and the way you’re a good mother is give your child food.” The conversation could start with that underlying parenting value: “I want to be the best mom I can be.”
If a child doesn’t seem to be taking his daily asthma medication, Dr. Wasserman said, “you can say, I notice that you haven’t refilled this medicine — the controller medicine — and Billy’s been in now for three episodes of wheezing. What’s going on here? Would it be O.K. if we talked about that — that’s the asking permission part.” And then perhaps you might hear from the parent that “steroid” — the asthma medication — is a scary word, that the parent associates it with performance enhancing drugs that get athletes into trouble.
This isn’t an easy skill to learn, Dr. Faith said, and it can take an organizational shift to support the training and get providers on board. Online modules are not as effective, she said. “You need individual feedback from an instructor.” But having mastered the skill, clinicians who start using it may experience less burnout. “The providers tend to feel they are making a difference in patients’ lives,” she said.