(Music playing in the background over opening text on screen.)
Text on screen:
Prevention in Hand
Motivating Patients to Adopt a Healthier Lifestyle
(DR. SELBY walks up to the camera. He then stands alone in a hallway. We can see several doors of examining rooms in the background. He addresses the camera directly. Background music fades, then stops.)
Text on screen:
Dr. Peter Selby
Centre for Addiction and Mental Health
University of Toronto
DR. SELBY: As a physician, it’s not unusual to see patients who are ambivalent about changing their behaviour: that is, they possess conflicting feelings on the issue. The scenario you’re about to see is a perfect illustration of how we can sometimes want two opposing things at the same time. The patient is a 40-year-old male attending a follow-up on his annual physical. His high blood pressure is not under control. Test results showed mildly elevated GGT, AST, ALT and MCV. His doctor suspects alcohol may be causing these issues. Motivational interviewing is an excellent way to help patients address alcohol misuse. By using the 5As - ask, assess, advise, assist and arrange - physicians are able to better understand their patient’s drinking behaviour and help them recognize their ambivalence to change. In doing so, they are able to come up with a plan of action that works.
(Background music)
Text on screen:
Addressing the Risk Factors for Chronic Disease:
Alcohol Misuse
(Background music fades, then stops. A female doctor and male patient are sitting across each other, interacting in an examining room.)
DOCTOR: Hi Stéphane.
PATIENT: Hi.
DOCTOR: How are you today?
PATIENT: I’m okay, how about you?
Text on screen:
Ask
DOCTOR: I’m good, and good to see you again. I wanted you to come back to the clinic today to discuss your borderline blood pressure, and also the results of your most recent blood work.
PATIENT: Okay.
DOCTOR: Was there anything you wanted to say before we start?
PATIENT: No.
DOCTOR: Alright. The blood work results I got today show that your liver enzymes are elevated. This is usually caused by your liver being inflamed, and the most common cause of this is alcohol.
PATIENT: Well, I don’t drink that much. It can’t be that bad.
Text on screen:
Assess
DOCTOR: If it’s okay with you, I’d like to get a better understanding of how much you drink.
PATIENT: Well, you know, I just drink socially.
Text on screen:
Relevance
DOCTOR: And when you say socially, what does that mean to you?
PATIENT: Well, you know, I go to the bar with buddies after work and we have a couple of drinks.
DOCTOR: When you say drinks, what kind of drinks and how many do you drink?
PATIENT: Well, you know, when I go to the bar, we – well I, I take about four pints. But on weekends, I drink bottles, so, I don’t know, Saturdays I’ll drink like twelve and maybe six on Sundays.
DOCTOR: Okay. Have you ever tried to cut down in the past?
PATIENT: Yeah. Like last year, I stopped for a whole month when my mom was at the hospital.
DOCTOR: Did anyone ever mention about your drinking, and does that annoy you?
PATIENT: Well, my wife does whine because, you know, she says I… I stink like stale beer and I snore a lot and that I wake up too early, and that bugs me.
DOCTOR: Mm-hmm. And have you ever felt guilty about the amount you’re drinking or what you’ve done while you were drinking?
PATIENT: No, never. You know, I’m responsible. Like I don’t really get drunk, I don’t get into fights, I never drink and drive and I never miss a day of work, you know? Like, it’s not a problem.
DOCTOR: Well that’s really good. Has it ever happened that you’ve needed a drink or medication to start off your day?
PATIENT: Ha, no. Like if I ever do, I’ll show up to detox right away.
Text on screen:
Assess / Risks
DOCTOR: Based on the information you’re providing me, although it is clear to me that you are not an alcoholic, the amount you’re drinking is concerning to me, and I think it is the cause of your inflamed liver. I think it probably also contributes to your poor sleep, your snoring and also why your blood pressure medications aren’t working as well as we would like them to.
PATIENT: Really?
Text on screen:
Assist
DOCTOR: Mm-hmm. Would you be interested in discussing ways to decrease your drinking?
PATIENT: Sure.
DOCTOR: Alright. So could you think of some ways you could reduce your drinking by yourself?
PATIENT: Well, for one, I guess I should stop going to the bar, like, and when I want a drink, I’ll have to do, like, club soda or a pop.
DOCTOR: Mm-hmm.
PATIENT: And I could, like, it’d probably be good if I do walks at night, you know, occupy my time a bit, yeah.
DOCTOR: Mm-hmm. And, how about on the weekends?
PATIENT: Well, on the weekends, I could easily stop buying beer for home because I’m the only one at home who drinks beer, so it wouldn’t be a problem if there’s no more. And, you know, talking to my wife, she’ll find stuff for me to do. She’ll keep me busy for sure.
Text on screen:
Roadblocks
DOCTOR: These are great ideas. Can you think of anything that could impede you decreasing your drinking?
PATIENT: Ah, well, my buddies for sure won’t be happy if I don’t show up to the bar, so they’ll try to get me to continue going.
Text on screen:
Advise
DOCTOR: Hmm. I have to say I would advise you to stop drinking entirely for the next three months.
PATIENT: Completely?
DOCTOR: Mm-hmm. What do you make of that?
PATIENT: Well, it’s not an attractive idea. But, you know, I don’t want to get cirrhosis.
Text on screen:
Rewards
DOCTOR: Mm-hmm. Well, if you stop now, you would decrease greatly your chances of developing chronic liver disease.
PATIENT: Okay.
DOCTOR: Alright. Would you agree if I would share some recommendations with you?
PATIENT: Yeah, of course.
DOCTOR: Alright. So you could read through that at home.
PATIENT: Okay.
Text on screen:
Arrange
DOCTOR: It takes about three months for all your blood tests to come back to normal. But if it’s okay with you, I’d like to check in in about a month to see how you’re doing.
PATIENT: Sure, that sounds fine.
DOCTOR: Alright, okay. So we’ll see you again in a month.
PATIENT: Thank you.
(Background music up. Fade to black.)
Text on screen:
THE COLLEGE OF FAMILY PHYSICIANS OF CANADA LOGO
Production of this video was made possible through a financial contribution from the Public Health Agency of Canada. The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada.
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