Motivational Interviewing Mistake: The Open Question That Closes

If you’re new to Motivational Interviewing, or even if you’ve been using it for a while, you probably know the importance of using open or open-ended questions. Open questions can’t be answered with a simple “yes” or “no”; rather, they encourage the patient to share information that you might not get otherwise. Sometimes, in our attempt to connect with a patient, we accidentally close our open question. This is a common Motivational Interviewing mistake. Here’s what that can look like:

“How have you been doing with the new medication — are you remembering to take it?”

What Just Happened?

“How have you been doing…” is an open question. It invites the patient to answer in their own words, sharing their experience. The patient has space to say anything — that they have been managing well, that they keep forgetting, that the side effects are making it difficult, that they cannot afford the full dose, that a family member has been helping them remember.

Then comes the second half: “are you remembering to take it?” That is a closed question. It has two possible answers: yes or no. And because it arrives immediately after the open question, it signals to the patient what kind of answer the practitioner expects. The question has been narrowed from everything to one thing. In most cases, the patient will answer the closed question. “Yes, mostly.” “I try to.” “Sometimes I forget.” The opportunities for insight that the first question might have produced never arrive because the second question replaced it before the patient had a chance to respond.

Why Does It Happen?

Why do we sabotage our first, open question? One reason is that we often have anxiety about silence. An open question requires the practitioner to wait for a response. The patient needs a moment to think, find the words, and then decide what to say. That pause can feel uncomfortable, especially if you are working in a second language and are asking yourself if the patient understood you. Silence in a clinical setting can feel like something has gone wrong. To avoid this pause, you add a follow-up closed question to fill the silence.

Another reason we tend to follow-up with a closed question is due to our training. In clinical training, closed questions are often the default. They are efficient, provide clear answers, and move the appointment forward. An open question followed immediately by a closed one is often the result of a practitioner who has learned to ask open questions but has not yet learned to trust them.

What’s the Solution?

The solution is quite obvious, but with most things, the implementation is the hardest part. Simply ask the open question, then stop. That’s it. “How have you been doing with the new medication?” Let the silence exist for a moment. The patient will soon respond, and what they say will almost always be more useful than a yes or a no. Listen for this pattern in your next interaction to see if you are undermining your ability to get important information from your patient.

For practitioners working in clinical English as an additional language, this interaction pattern is worth specific attention. Your instinct to complete a patient’s thought is likely stronger when you are also monitoring your own grammar, vocabulary, and pace of the consultation simultaneously. The closed question at the end can feel like finishing a sentence properly. It is worth recognizing that the unfinished sentence is the better clinical tool.

Want to Go Further?

This is one concept covered in my course, Motivational Interviewing in English for International Healthcare Professionals — a practical six-module course on the specific English language skills that make MI possible in real clinical interactions. It includes a downloadable reference card toolkit, phrase bank, and a 20% discount on an individual coaching session.  You can find more information here: www.absolutelyenglish.com/courses