The Case of Fred Higgins
last authored: Jan 2011, David LaPierre
last reviewed:
farmer, 1974. Courtesy of Jane Cooper
Fred Higgins is a 54 year-old man who has been a patient of yours for the past 4 years. He has poorly controlled hypertension, smokes over a pack a day, and has an unhealthy diet. He comes in regularly, but your repeated efforts to address his health choices have not worked.
Of course, you remain very concerned about Fred's chances of developing a serious health condition, given his risk factors.
You recently attended a workshop on Motivational Interviewing and believe the tools you learned may be helpful.
The next time Fred is in the office (for a suspicious skin lesion you've agreed to biopsy). How do you introduce the question of Fred's lifestyle choices?
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Fred responds, "Well, I've been thinking a great deal about the smoking, actually, doc. My wife's been nagging me to quit since she did last year. She says it's disgusting when I smoke. But I just don't think I have what it takes to quit."
How do you respond?
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Fred answers, "I guess I'd be around a four out of ten right now."
How do you respond?
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Fred: "I can work hard when I want to. If I had the right help, I think I could do it. I just don't know what that help should look like for me."
You realize Fred has started describing his ability to change. Before you explore this, you decide to ask him for more reasons to quit. He has already given you one reason (it grosses his wife out). How can you elicit this from him?
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Fred describes how cigarettes calm him down when stressed, and also are a social thing for him, as he smokes with the guys at work. He thinks, then tells you how smoking is expensive and how he knows it's bad for his health. He worries about the cough he's had for the past few months.
You next want to address Fred's ability to quit. What can you ask him?
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Fred answers, "I guess with the stress, it would be nice to have something that could replace the cigarette. What do you think? And with the guys at work, I could make sure I talk with them over lunch. And maybe I could convince them to quit smoking too!"
How do you respond to this?
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Fred tells you he's actually been thinking about the patch and the gum. He says he'd like to take some time and think about this, and talk with his wife and friends who have used NRT.
How do you respond to this?
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