Assessing Readiness to Change

Friday, January 27th, 2006
This post was written by Melanie Matthews

Motivational interviewing, readiness to change, stages of change, modifying patient behavior, we’re hearing a lot of these terms thrown around in discussions on disease and lifestyle management.

My dad often relays the story of how he quit smoking 30 some odd years ago: his physician at the time was a Navy-trained physician who said, if you don’t stop smoking, you will get “f*&%ing” bronchitis, you will get “f*&%ing” emphysema, you will get “f*&%ing” cancer and you will “f*&%ing” die.

While I don’t think what his doctor told him would fall under motivational interviewing, it was enough to do the trick. He stopped smoking that day and never went back.

This story came to my mind after reading an article on a study by researchers at The Children’s Hospital of Philadelphia and the University of Pennsylvania who found that a mother’s cigarette smoking increases the risk that her newborn may have extra, webbed or missing fingers or toes.

While I’m not advocating that OBs be as harsh as this particular doctor was about the impact of smoking, maybe we do need to be a little bit stronger in our approaches. Would it have an impact on pregnant smokers if they were to learn as this study found that women who smoked more than a pack of cigarettes a day during pregnancy were 78 percent more likely to have babies with digital anomalies?

I hope so. But are we giving patients this information? Or are we so busy assessing their readiness to change that we fail to give them the cold, hard facts about the impact that their behaviors can have not only on their own health, but their baby’s health as well.

Don’t get me wrong. I think these tactics – motivational interviewing, stages of change and modifying patient behavior – are important steps in getting patients to accept responsibility for their own behaviors, but maybe some facts should also be added into the mix.

In our report, “Motivating Resistant Patients: Influencing Behaviors to Improve Outcomes,” we discuss why patients are resistant to change and how to approach these patients who are resistant. It may not be all about the lecture, but it has to have some role.

Getting back to my dad, 30 years later, he was sitting in a physician’s waiting room yesterday next to a girl who was four months pregnant. She revealed that she has been able to cut down to just five cigarettes a day now that she is pregnant. He asked, “What does your doctor say about that?” Here’s hoping the doctor is saying something.

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