A 54-year-old man comes to the clinic for a routine health maintenance examination. He has a 30-pack-year smoking history and currently smokes one pack of cigarettes daily. When the physician asks about his tobacco use, the patient crosses his arms and says, "My grandfather smoked two packs a day and lived to be 90. I feel perfectly fine, and I don't see any reason to put myself through the stress of quitting right now."
Which of the following is the most appropriate initial response by the physician?
- Would it be alright if I shared some information with you about how smoking might be affecting your health?Cevap
- BSince you are legally competent to make your own decisions, I will document your refusal and we will not discuss this topic further.
- CAccording to preventive guidelines, I must order a low-dose CT scan of your chest right now because of your smoking history.
- DI will order a routine chest X-ray today to ensure that your lungs do not have any hidden damage.
- EYou should know that smoking induces cytochrome P450 enzymes, which will cause critical drug interactions if you ever need other medications.
Cevap
The most appropriate response is to ask for permission to share information about the health effects of smoking.
The patient is in the precontemplation stage, as evidenced by his belief that smoking is not harmful to him and his lack of intent to quit. In this stage, confronting the patient or forcing information typically increases resistance. The most appropriate initial step in motivational interviewing is to ask for permission to provide information (the 'Ask-Tell-Ask' framework). This respects his autonomy and increases the likelihood that he will be receptive to the education provided.
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For patients in the precontemplation stage of behavior change, the most effective counseling strategy is to avoid argumentation and ask for permission before sharing health information.
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