To Change or Not To Change: “Sounds Like You Have a Dilemma”

• Dangerous behavior
• Life style
• Physician role
• Office vistis
• Counseling

One of a physician's most important tasks is to help patients change unhealthy behaviors, such as smoking, hazardous alcohol use, overeating, or physical inactivity. Such lifestyle changes often affect the outcome of care more than any other medical treatments that physicians have to offer. Physicians can play a pivotal role in helping patients make these changes, even during brief office visits (1, 2). Yet, physicians seldom effectively counsel patients about behavior changes during routine office visits because of time limitations and a suspicion that urging patients to change long-standing habits can be fruitless. Since only 20% of patients seeking medical care are ready to change unhealthy behavior, it is not surprising that physicians feel frustrated (3).

Better strategies and more effective language can increase physicians' effectiveness in counseling even within the confines of a brief office visit (1, 2). In this article, we explain a clinically useful model for counseling and provide sample words and phrases to illustrate how physicians can influence change. We use the example of counseling for smoking cessation because smoking is critically important to the health of the U.S. population (4-10). However, the principles and the language can be applied equally to other health behaviors, including dietary changes, exercise, alcohol and drug use, or medication adherence. We offer examples of actual dialogue to illustrate specific language and words that practicing physicians can use to help patients make lifestyle changes. The strategies and examples are designed to be practical, simple, and feasible in a busy office setting.