SUMMARIES
Summaries are a type of reflection. However, summaries are reflections that pull together several
things that the patient has said.
There are different types of summaries with different types of functions:
Client centered summary
•All main things patient has said
Decisional balance summary
•Both sides of ambivalence equally
Change talk bouquet
•Change talk
Confrontational summary
•Sustain talk
Transitional summary
•Transition from one topic to another
•E.g. Summary to transition to key question and planning
Concluding summary
•Summarize and present patient with change talk bouquet to conlclude the interview

The exercise below should help you understand how one might go about creating a summary.
Read through the case and follow the instructions at the end.
Dr. Clark's Referral
Following a routine physical examination, Dr. Clark referred Sylvia to a behavioral
health counselor to discuss her drinking. The referral indicates that the physician smelled alcohol
on her breath during the examination and added an alcohol screen to the panel of lab tests
ordered. The lab report indicated a blood alcohol level of 90mg%, and also a slightly elevated
GGT level. After introductions, the consultation begins.
Clinician (C): There's not much information on this referral, Sylvia. Perhaps you could tell me
how you understand why Dr. Clark wanted you to talk with me.
Patient (PT): I was surprised to hear from her. She called me on the phone after my physical,
and said she wanted me to see you because she was concerned about me.
C: Dr. Clark called you personally.
PT: Uh huh. Actually it kind of scared me. I thought maybe it was bad news from my tests.
C: So what did she tell you?
PT: Well that morning, when I went in for my physical, while she was examining me she
mentioned that she smelled alcohol. I thought it was probably the mouthwash that I use, and
that's what I told her. She didn't say anything more about it.
C: But then she called you back.
PT: I guess she had them test for alcohol. I didn't know she was going to do that. Anyhow she
told me that I was over the legal limit for driving. But I swear I didn't have anything to drink.
C: That took you by surprise.
PT: Yes. I never drink in the morning. She also told me that one of the other tests was abnormal -
for liver, I think - and that's why she wanted me to talk to you.
C: I'm sure this has been on your mind in the meantime. What are you thinking at this point
about what she told you?
PT: Well, frankly, I don't like being here. I didn't like her checking up on me like that, and I feel
like this is none of her business, or yours either for that matter. I didn't really want to come.
C: And yet you did.
PT: It did scare me a little. She didn't really explain the lab test to me, except that it might mean I
was drinking too much. Did she explain it to you?
C: She did send me the result, and the one she mentioned is called GGT. It's a liver function test

you're right about that - and it is one that goes up when a person drinks a fair amount. It's like a
warning light. What do you make of that?
PT: I don't like it. I guess that's what she was worried about. I know she means well.
C: She cares about you. And she must have been concerned about the alcohol in your system,
too. What time did you go in for your physical?
PT: It was first thing in the morning, on my way to work. I just got up, showered, got ready, and
went in. I didn't even have breakfast because of the blood tests.
C: So that's a puzzle for you, how the alcohol got there in the morning.
PT: I guess it must have been left over. Can that happen? I don't really drink all that much.
C: Sure. It takes some time for the liver to break down alcohol, so it can stay in the body for a
while.
PT: But she said I was legally drunk! I live way over on the west side, and I work downtown, so
I drive in that awful traffic every morning. I felt perfectly fine.
C: Nothing out of the ordinary.
PT: No. But she said if I had been pulled over, I could have been arrested.
C: That kind of shocked you.
PT: I work for the city, for the mayor's office, and if that happened – well, I could lose my job.
C: All right. Well, I can see why you came in, and I'm glad that you did. All of this is new to
you, and you're not happy to be here, but Dr. Clark got your attention. So shall we talk about this
a bit?
PT: OK, but I don't want to be lectured about drinking.
C: I won't lecture you, I promise. Now if it's all right with you, perhaps you could tell me some
about how alcohol fits into your life, into an ordinary day.
PT: An ordinary day. I work a long day, and by the time I get home I'm exhausted and ready to
relax. I'll usually have some wine while I'm making dinner. If I don't have the kids, I just fix
something quick, and then kick back.
C: It makes a difference if the kids are there or not.
PT: Well, I'll usually have wine with dinner anyhow, and while I'm cooking, but I mean I make
something a little nicer when they are there. I'm divorced. Most of the time he has the kids.
That's not how it's supposed to be, but he's always been a control freak.
C: And then after dinner you kick back and relax.
PT: Right. I usually just watch television. I don't have energy for much more than that.
C: And how does alcohol fit in there?
PT: It helps me relax and just kind of turn off. I'll have some more wine, maybe a martini while
I'm watching programs. Then I get tired, go to bed, get up, and do it all over again. That's when
the kids aren't with me.
C: And when they are . . .
PT: We'll watch TV together, unless they have some homework and then I help them with that. I
guess I don't drink as much when they're there. Then in the morning I have to get them to school
before work, and it gets pretty hectic. I like it when they're with me, though.
C: You have an arrangement with your ex.
PT: We have joint custody, and I'm supposed to have them Monday through Wednesday and
every other weekend. But it doesn't happen. Like I said, he's a control freak. He always
dominates me - has to have it his way. If he says they don't come over, they don't. So a lot of the
time I don't get them.
C: It's not happening the way the court ordered it.
PT: Right. But I can't take him to court. I can't afford a good lawyer, and he says if I complain
he'll say I'm a drunk and file for sole custody. I can't afford to fight him. [Pause, some
tearfulness] I love my kids, and I feel so much better when they're with me. They belong with
me.
C: In what ways do you feel better when they're there?
PT: I just feel more cheerful. I have something to do. Usually when I wake up in the morning I
feel terrible, nervous, exhausted, like I don't want to get out of bed, but I still do. When the kids
are there, it's like I have a reason to get up.
C: And those are also days on which you drink somewhat less, when they are with you.
PT: Oh, I see what you're getting at. You think one reason I feel worse on other mornings is that
I'm drinking too much.

C: Just a possibility.
PT: Well, there's probably something to that, but I also miss my kids.
C: It hurts you, too, when they're not with you. And at the same time, you wonder if maybe you
feel worse some mornings because of drinking the night before.
PT: I don't think I'm really hung over or anything, but I do feel pretty bad. Headache and so
forth. Maybe so. But I'm not an alcoholic or anything like that.
STOP! Before reading any further, write no more than seven sentences that you would choose to
summarize what the client has said thus far. End your summary with a question.

Dr. Clark's Referral: Four Possible Summaries
Below are four possible summaries of the above dialogue, all intended to be helpful to Sylvia.
What is being emphasized in each one? In each summary, what seems to have guided the
counselor in choosing what to include or not include? How consistent is each summary with the
spirit and style of motivational interviewing? Why?
Summary 1
Well, it sounds like your life is pretty stressful. When you wake up in the morning you often feel
bad. You have a stressful commute in traffic in the morning, and you put in a lot of time at work.
By the time you get home, you're exhausted. You're a single mom now, and there's a constant
battle with your ex about getting time with your kids. You really miss them when they're not
with you, but you also feel kind of helpless to do anything about it. Mostly what you do in the
evening is watch TV, and alcohol helps you to relax. Have I got it right?
Summary 2
Let me tell you what I hear so far. Because of some lab tests, Dr. Clark is concerned that you are
drinking too much, and asked you to talk to me. You're wondering what the lab test means, and
you don't understand how you could still have been legally drunk that morning. Some mornings
you do feel pretty bad, though. On the other hand, alcohol helps you to relax, and you don't think
you really drink all that much. You don't drink in the morning, and you certainly don't think
you're an alcoholic. You weren't too happy to come here, and you don't want to be lectured about
drinking. Is that about right?
Summary 3
So here's what you've told me so far. Dr. Clark noticed a blood test elevated that often is a
warning about drinking too much, and she was concerned enough to call you personally. That
scared you a little. You were also surprised that there was still enough alcohol in your
bloodstream for you to be arrested for drunk driving if you had been stopped, even though you
had not had anything to drink in the morning. If that happened, you could lose your job. When
you wake up in the morning you often feel pretty bad - headache, tired, nervous. That seems to
happen more when the kids aren't with you, and you drink more at night. What else have you
noticed?
Summary 4
Well, I'd say you have a serious problem with alcohol. You say you don't drink that much, but
you're drinking enough at night that you're still legally intoxicated in the morning when you're
driving to work or taking your kids to school. The way you're feeling bad in the morning sounds
a lot like alcohol withdrawal to me. You're using alcohol like a drug to relax you and help you
forget about the stresses in your life. Your ex-husband thinks you have a problem and doesn't
want the children to be with you. So you watch television and drink, and deny that you have a
problem. Sure sounds like alcoholism to me! How about you?

Discussion
Summary 1 is a classic client-centered summary. It emphasizes the person’s (predominantly
negative) feelings, perhaps with a goal of helping the person to become more aware and
accepting of her current experience. This kind of summary also has a function of joining with the
client, communicating understanding and acceptance. For these reasons, this summary is
compatible with an MI style, but it lacks the important goal-oriented component of MI and is not
likely to create movement in the direction of change.
Summary 2 is a decisional balance summary. The counselor seeks to summarize both the pros
and the cons of change that Sylvia has expressed, giving them approximately equal emphasis.
The underlying mental model is that people need to see clearly and explore both sides of their
dilemma. This is an appropriate type of summary when the counselor is not seeking to move the
client in a particular direction; for example, when the client is trying to make a choice and the
counselor is at “equipoise” – not advocating for one side or the other. Like Summary 1, it lacks
the directional movement of MI.
Summary 3 is a quintessential MI summary. It offers a bouquet of change talk that Sylvia has
offered. There is something powerful about hearing all of one’s change talk collected, and such a
summary is strategic, consciously directed toward change. This collecting summary ends with an
open question intended to elicit further change talk.
Summary 4 is a confrontational summary, and is inconsistent with MI. The apparent assumption
is a deficit model, that the client is not perceiving reality and needs to be strongly persuaded

bunu asagıda verecegim dataset e gore uyarlayabilir misin hicbir değişiklik yapmadan

PROMPT:
---
 
I am developing an AI lifestyle medicine coach for my mobile app. The target users are individuals seeking lifestyle improvements, preventative health, and wellness solutions, as well as those looking to consult a health and wellness coach.
 
The AI coach must behave similarly to a human health professional who has educated themselves in lifestyle medicine, following the guidelines, principles, and knowledge from books, publications, and resources. This AI coach should have extended knowledge and act according to the evidence-based approach of lifestyle medicine, which is why I am preparing a dataset from these resources.
 
Since I am not a technical person or developer, I will need your guidance to ensure the data preparation and AI training process goes smoothly, especially when creating files like JSON.
 
Here is my data preparation pipeline for training the AI:
1. **Data Preparation Format**: I clean the text from books and publications, divide it into parts (such as chapters or sections), and format it for AI training.
2. **AI Text Conversion**: I provide you with the cleaned text in parts, and I need you to convert it into a format suitable for AI training.
3. **Sample Prompts and Guiding Questions**: After all the data is prepared for the chapter, I will ask you to generate more sample prompts for AI training and create more simplified guiding questions.
4. **Final Step**: After all the data is prepared and extended, I will need your help to create JSON files for each part of the chapters to feed into the AI system, ensuring no critical information is lost.
 
Here is the data preparation format I use:
 
---
 
**Data Preparation Format:**
- **Title:** (Title of the book or publication)
- **Chapter #:** (Name of chapter; if this is an article or publication without chapters, remove this)
- **Part:** (Name of the part)
- **Summary:** A short paragraph summary of the part
- **Summary of the Content:** Main theme and key concepts
- **Main Theme:** Explanation of the main theme of the part in sentence format
- **Key Concepts:**
   - A bullet point breakdown of the key concepts of the part
- **Key Concepts Breakdown:**
   - **Concept #:** Title
   - **Definition**
   - **Example**
- **Key Learning Objectives:** (In bullet points)
- **Sample Prompts for AI Training:** Scenario-based questions and expected AI responses
- **Simplified Guiding Questions for AI:** (In bullet points)
 
---
 
Here’s an **example** of data preparation from another book (for format reference only, not content):
 
---
 
**Book Title:** LIFESTYLE MEDICINE HANDBOOK: An Introduction to the Power of Healthy Habits  
**Chapter 1:** Understanding Lifestyle Medicine  
**Part:** Introduction to Lifestyle Medicine  
 
---
 
**Summary:**  
This part introduces the field of lifestyle medicine, its relevance in today's healthcare, and its potential to positively impact individual and societal health. It lays the foundation for understanding how lifestyle changes, backed by evidence-based medicine, can prevent and even reverse chronic diseases, and outlines the role of healthcare professionals in this growing field.
 
---
 
**Summary of the Content:**  
**Main Theme:** The foundational concepts of lifestyle medicine, its evidence-based nature, and its importance in addressing the modern health crisis.  
**Key Concepts:**  
- **Introduction to Lifestyle Medicine:** Defining lifestyle medicine and its role in healthcare.  
- **Evidence-Based Medicine:** The role of scientific evidence in guiding lifestyle interventions for chronic disease prevention and treatment.  
- **Healthcare System Needs:** The healthcare system's shift from treating disease to preventing it through lifestyle changes.
 
---
 
**Key Concepts Breakdown:**  
 
- **Concept 1: Introduction to Lifestyle Medicine**  
  - **Definition:** Lifestyle medicine refers to the use of therapeutic approaches, such as a plant-based diet, regular exercise, adequate sleep, stress management, and avoiding risky substance use, to prevent, treat, and reverse lifestyle-related chronic diseases.  
  - **Example:** Lifestyle medicine interventions are used to treat chronic conditions like heart disease, diabetes, and obesity by addressing the root causes of these diseases.
 
- **Concept 2: Evidence-Based Medicine**  
  - **Definition:** Lifestyle medicine relies on scientific studies and data to provide treatments that are proven to work. It focuses on evidence-based therapeutic approaches to prevent and treat diseases.  
  - **Example:** Clinical trials have shown that lifestyle interventions, such as diet and exercise, can be more effective than medications in preventing diseases like type 2 diabetes.
 
- **Concept 3: Healthcare System Needs**  
  - **Definition:** The current healthcare system is reactive and focused on disease treatment, leading to high costs and a growing burden of chronic diseases. Lifestyle medicine shifts the focus to prevention and long-term health improvements through lifestyle changes.  
  - **Example:** Preventing diseases like heart disease and diabetes through lifestyle medicine can reduce the overall burden on the healthcare system, improving patient outcomes and lowering costs.
 
---
 
**Key Learning Objectives:**  
- Understand the definition and role of lifestyle medicine in today's healthcare.  
- Recognize the importance of evidence-based medicine in guiding lifestyle interventions.  
- Identify how lifestyle medicine addresses the healthcare system’s need to prevent chronic diseases rather than just treating them.
 
---
 
**Sample Prompts for AI Training:**  
 
- **Scenario-based Question 1:**  
  "What is lifestyle medicine, and how does it differ from traditional approaches to healthcare?"  
  **Expected AI Response:**  
  "Lifestyle medicine focuses on preventing, treating, and reversing chronic diseases through lifestyle changes, such as diet, exercise, and stress management. Unlike traditional approaches, which focus on treating diseases with medication, lifestyle medicine addresses the root causes of diseases."
 
- **Scenario-based Question 2:**  
  "Why is evidence-based medicine important in the field of lifestyle medicine?"  
  **Expected AI Response:**  
  "Evidence-based medicine ensures that lifestyle interventions, like diet and exercise, are supported by scientific studies and proven to be effective. This approach helps healthcare professionals provide reliable and effective treatments for preventing and managing chronic diseases."
 
- **Scenario-based Question 3:**  
  "How can lifestyle medicine address the needs of the current healthcare system?"  
  **Expected AI Response:**  
  "Lifestyle medicine helps shift the focus of healthcare from treating diseases to preventing them. By encouraging healthy behaviors, such as regular exercise and a nutritious diet, lifestyle medicine reduces the burden of chronic diseases, which lowers healthcare costs and improves patient outcomes."
 
---
 
**Scenario-Based Learning for Part 1:**  
 
### **Scenario 1: Explaining Lifestyle Medicine to a New Patient**  
**Context:**  
You are a physician seeing a new patient who has never heard of lifestyle medicine. The patient is curious about how it differs from regular medical care and how it can help them.  
 
**Scenario:**  
The patient says:  
"I’ve heard of medications and surgeries, but what is lifestyle medicine? How is it different from what most doctors do?"  
 
**Decision Points:**  
1. How do you define lifestyle medicine for this patient?  
   - **Option A:** "Lifestyle medicine focuses on using healthy habits, like diet and exercise, as the main treatment for many chronic diseases."  
   - **Option B:** "Lifestyle medicine is about managing your health without ever needing medications or other treatments."
 
   **Feedback:**  
   - **Option A:** Correct! Lifestyle medicine uses evidence-based lifestyle changes, such as diet, exercise, stress management, and sleep, as primary interventions to prevent, treat, and sometimes reverse chronic diseases.  
   - **Option B:** Incorrect. While lifestyle medicine emphasizes lifestyle changes, it does not exclude medications or other treatments when necessary.
 
2. The patient asks, "Is lifestyle medicine only for people who are sick?"  
   - **Option A:** "No, lifestyle medicine is for everyone. It helps people both prevent disease and manage their health."  
   - **Option B:** "Yes, it's mainly for people who already have chronic diseases."
 
   **Feedback:**  
   - **Option A:** Correct! Lifestyle medicine is preventive as well as therapeutic. It can be used to help people stay healthy, as well as to treat those who already have conditions like diabetes or heart disease.  
   - **Option B:** Incorrect. Lifestyle medicine is beneficial for both preventing diseases and improving the health of those who are already managing chronic conditions.
 
---
 
### **Scenario 2: Lifestyle Medicine’s Role in Preventing Chronic Diseases**  
**Context:**  
You are hosting a community health workshop, and a participant is asking about how lifestyle medicine can prevent chronic diseases.  
 
**Scenario:**  
The participant says:  
"I understand that medications help treat diseases, but how can lifestyle medicine actually prevent them?"  
 
**Decision Points:**  
1. How do you explain the preventive role of lifestyle medicine?  
   - **Option A:** "Lifestyle medicine helps prevent diseases by focusing on improving daily habits, such as eating a plant-based diet, exercising, managing stress, and sleeping well."  
   - **Option B:** "Lifestyle medicine only helps prevent diseases if you start it at a very young age."
 
   **Feedback:**  
   - **Option A:** Correct! Lifestyle medicine addresses the root causes of chronic diseases by promoting healthy lifestyle habits like proper nutrition, physical activity, and stress management, regardless of age.  
   - **Option B:** Incorrect. While starting healthy habits early is beneficial, lifestyle medicine can be implemented at any age to prevent and manage diseases.
 
2. The participant asks, "Can lifestyle medicine be as effective as medications for preventing diseases like heart disease or diabetes?"  
   - **Option A:** "Yes, in many cases, lifestyle medicine can be more effective than medications in preventing and even reversing chronic diseases."  
   - **Option B:** "No, lifestyle medicine is more of a supplement to medications."
 
   **Feedback:**  
   - **Option A:** Correct! Evidence has shown that lifestyle medicine can be highly effective, and in some cases, more effective than medications, particularly in preventing and managing conditions like heart disease, diabetes, and obesity.  
   - **Option B:** Incorrect. While lifestyle medicine can be used alongside medications, it is often a first-line treatment that can reduce or even eliminate the need for medications in some cases.
 
---
 
### **Scenario 3: The Core Components of Lifestyle Medicine**  
**Context:**  
During a medical consultation, a patient asks about the specific lifestyle changes involved in lifestyle medicine.  
 
**Scenario:**  
The patient says:  
"I’m interested in making changes to improve my health. What are the main lifestyle areas I should focus on?"  
 
**Decision Points:**  
1. How do you explain the core components of lifestyle medicine?  
   - **Option A:** "You should focus on eating well, staying active, managing stress, sleeping well, and avoiding harmful substances like tobacco."  
   - **Option B:** "It’s all about exercise and getting enough sleep."
 
   **Feedback:**  
   - **Option A:** Correct! Lifestyle medicine focuses on six key areas: nutrition, physical activity, stress management, sleep, social connections, and avoidance of risky substances like tobacco and alcohol.  
   - **Option B:** Incorrect. While exercise and sleep are important, lifestyle medicine is a comprehensive approach that includes several other key areas, such as nutrition and stress management.
 
2. The patient asks, "Does this mean I have to make all these changes at once?"  
   - **Option A:** "You can make gradual changes over time, focusing on one area at a time."  
   - **Option B:** "Yes, you need to make all these changes right away for it to work."
 
   **Feedback:**  
   - **Option A:** Correct! It’s important to encourage gradual, sustainable changes. Patients can start with one area, such as nutrition or exercise, and slowly incorporate other elements of lifestyle medicine.  
   - **Option B:** Incorrect. Making all changes at once can be overwhelming. The goal is to build sustainable habits over time.
 
---
 
**Simplified Guiding Questions for AI:**  
- What is lifestyle medicine?  
- Why is scientific evidence important in lifestyle medicine?  
- How can lifestyle medicine improve healthcare and reduce costs?