No More Righting Reflex: Improving Patient Outcomes by Effectively Addressing Resistance

If you’ve worked in healthcare, you’ve encountered resistant or "difficult" patients. These are patients who seem to struggle with motivation to change their behaviors. They express to you that they don’t really want to change their diet, or exercise, or take their medication. Your response is to explain things clearly, patiently, thoroughly. You think if you could just make the patient understand your argument, they would follow your instructions. Instead of convincing the patient, the patient often resists more. Let’s talk about the “righting reflex,” why it usually doesn’t work, and how we can use Motivational Interviewing (MI) instead to support improved patient outcomes.

The Righting Reflex

The righting reflex refers to our clinical instincts to correct, explain, and persuade. It is typically our default response to patient resistance. We restate our recommendation more clearly, providing more evidence, or constructing a better case for change. This reaction stems from the fact that healthcare education is built on the premise that knowledge produces behavior change; if patients understand their condition well enough, they will make better decisions. The righting reflex is that premise expressed in real time: if the patient is not changing, they must not understand clearly enough yet.

Understanding a risk and being ready to act on it, however, are entirely different psychological states. A patient who smokes knows smoking is harmful. A patient who is sedentary knows exercise is beneficial. Knowledge is rarely the barrier. Readiness, confidence, and perceived relevance usually are better predictors of change. None of these factors respond especially well to more information or better arguments.

Making Things Worse Instead of Better

When patients feel pushed toward action, even if it benefits them, they tend to push back. This is not stubbornness. The patient perceives a threat to their autonomy, and this reaction of “not wanting to be told what to do” is a well-documented psychological response. The harder the practitioner argues for change, the more the patient argues for the status quo.

What To Do Instead?

Don’t simply agree with the patient that change is unnecessary. In fact, instead of agreeing, respond with curiosity rather than counterarguments. Ask what would need to be different to motivate the change rather than (re-)explaining why things need to change. The language difference between a righting reflex response and a Motivational Interviewing response is often small, but the clinical difference can be significant. Here are examples of how the righting reflex (first interaction) and MI responses (second interaction) differ in the same situation:

Patient: I am not really interested in changing my diet right now. 

Practitioner: I understand, but the evidence really is clear that diet has a significant impact on your condition. Even small changes like cutting back on refined carbohydrates, for example, can make a meaningful difference to your blood sugar levels.

Compared to:

Patient: I am not really interested in changing my diet right now. 

Practitioner: That’s valid — you have a lot going on right now. But what would need to be different for it to feel worth thinking about?

In the second example, MI provides a fundamentally different orientation to the conversation — one in which the practitioner's job is to explore and create the conditions for change rather than to argue for the change.

Language Matters

For healthcare professionals working in English as an additional language, the righting reflex presents a particular challenge. Under the pressure of a clinical consultation in a second language, the instinct to fall back on familiar patterns is strong. Explaining, instructing, and providing information are linguistically straightforward. Reflective listening, exploring ambivalence, and handling resistance require specific English phrases — and those phrases need to be ready when the moment arrives, not constructed on the spot.

This is the gap that most MI training does not address. Understanding the righting reflex conceptually and being able to override it in real time, in English, with a patient waiting, are two different things. The second requires language preparation as much as clinical knowledge.

In order to close this language gap, I created a short course for healthcare providers working in English as an additional language: Motivational Interviewing in English for International Healthcare Professionals. This course covers the righting reflex, the language of open questions, reflective listening, affirming, summarizing, and handling resistance — all through the lens of clinical English. Every module includes real examples, annotated dialogues, and ready-to-use language frameworks and phrase banks.  If your clinical appointments are in English and English is not your first language, it was built for you. 

www.absolutelyenglish.com/courses