To Change or Not To Change: “Sounds Like You Have a Dilemma”
Authors: Wendy Levinson, Marc S. Cohen, Donald Brady, F. Daniel Duffy
Journal: Annals of Internal Medicine (2001)

Medical Writings4 September 2001To Change or Not To Change: “Sounds Like You Have a Dilemma”Wendy Levinson, MD, Marc S. Cohen, MD, Donald Brady, MD, and F. Daniel Duffy, MDWendy Levinson, MDDr. Levinson: University of Chicago; Chicago, IL 60637Dr. Cohen: Medical College of Georgia; Augusta, GA 30912-4050Dr. Brady: Emory University School of Medicine; Atlanta, GA 30303Dr. Duffy: American Board of Internal Medicine; Philadelphia, PA 19106Search for more papers by this author, Marc S. Cohen, MDDr. Levinson: University of Chicago; Chicago, IL 60637Dr. Cohen: Medical College of Georgia; Augusta, GA 30912-4050Dr. Brady: Emory University School of Medicine; Atlanta, GA 30303Dr. Duffy: American Board of Internal Medicine; Philadelphia, PA 19106Search for more papers by this author, Donald Brady, MDDr. Levinson: University of Chicago; Chicago, IL 60637Dr. Cohen: Medical College of Georgia; Augusta, GA 30912-4050Dr. Brady: Emory University School of Medicine; Atlanta, GA 30303Dr. Duffy: American Board of Internal Medicine; Philadelphia, PA 19106Search for more papers by this author, and F. Daniel Duffy, MDDr. Levinson: University of Chicago; Chicago, IL 60637Dr. Cohen: Medical College of Georgia; Augusta, GA 30912-4050Dr. Brady: Emory University School of Medicine; Atlanta, GA 30303Dr. Duffy: American Board of Internal Medicine; Philadelphia, PA 19106Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-135-5-200109040-00027 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail 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 ...References1. Miller WR, Rollnick S. Motivational Interviewing: Preparing People To Change Addictive Behavior. New York: Guilford Pr; 1991. Google Scholar2. Gruenninger UJ, Duffy FD, Goldstein MG. Patient education in the medical encounter: how to facilitate learning behavior change and coping.. In: Lipkin M Jr, Putnam SM, Lazare A, eds. The Medical Interview: Clinical Care, Education and Research. New York: Springer-Verlag; 1995:122-34. Google Scholar3. Prochaska JO. Changing for Good. New York: William Morrow; 1994. Google Scholar4. Guise B, Goldstein M. Behavior change: the example of smoking cessation.. In: Nobel J, eds. Textbook of Primary Care Medicine. St. Louis, MO: Mosby; 2001:479-85. Google Scholar5. . The Agency for Health Care Policy and Research Smoking Cessation Clinical Practice Guideline. JAMA. 1996;275:1270-80. [PMID: 8601960] CrossrefMedlineGoogle Scholar6. Fiore M. Smoking Cessation: Smoking Cessation Guideline Panel. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, Centers for Disease Control and Prevention; 1996. Google Scholar7. Goldstein MG, Niaura R, Willey-Lessne C, DePue J, Eaton C, Rakowski W, et al . Physicians counseling smokers. A population-based survey of patients' perceptions of health care provider-delivered smoking cessation interventions. Arch Intern Med. 1997;157:1313-9. [PMID: 9201005] CrossrefMedlineGoogle Scholar8. Hughes JR, Goldstein MG, Hurt RD, Shiffman S. Recent advances in the pharmacotherapy of smoking. JAMA. 1999;281:72-6. [PMID: 9892454] CrossrefMedlineGoogle Scholar9. Ockene JK. Physician-delivered interventions for smoking cessation: strategies for increasing effectiveness. Prev Med. 1987;16:723-37. [PMID: 3317393] CrossrefMedlineGoogle Scholar10. Prochaska JO, Goldstein MG. Process of smoking cessation. Implications for clinicians. Clin Chest Med. 1991;12:727-35. [PMID: 1747990] CrossrefMedlineGoogle Scholar11. Prochaska JO, DiClemente CC. Toward a comprehensive model of change.. In: Miller WR, eds. Treating Addictive Behaviors. New York: Plenum Pr; 1986:3-27. Google Scholar12. Meichenbaum D, Turk DC. Facilitating Treatment Adherence: A Practitioner's Guidebook. New York: Plenum Pr; 1987. Google Scholar13. Bandura A. Social Foundation of Thoughts and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice Hall; 1986. Google Scholar14. O'Connell D. Behavior change.. In: Feldman MD, Christensen JF, eds. Behavioral Medicine in Primary Care: A Practical Guide. Stamford, CT: Appleton & Lange; 1997:125-35. Google Scholar15. Gordon GH, Duffy FD. Educating and enlisting parents. Journal of Clinical Outcomes Management. 1998;5:45-50. Google Scholar16. Rollnick S, Mason P, Butler C. Health Behavior Change: A Guide for Practitioners. New York: Churchill Livingstone; 1999. Google Scholar17. Smith RC, Lyles JS, Mettler J, Stoffelmayr BE, Van Egeren LF, Marshall AA, et al . The effectiveness of intensive training for residents in interviewing. A randomized, controlled study. Ann Intern Med. 1998;128:118-26. [PMID: 9441572] LinkGoogle Scholar18. Mullen PD, Simons-Morton DG, Ramírez G, Frankowski RF, Green LW, Mains DA. A meta-analysis of trials evaluating patient education and counseling for three groups of preventive health behaviors. Patient Educ Couns. 1997;32:157-73. [PMID: 9423498] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Dr. Levinson: University of Chicago; Chicago, IL 60637Dr. Cohen: Medical College of Georgia; Augusta, GA 30912-4050Dr. Brady: Emory University School of Medicine; Atlanta, GA 30303Dr. Duffy: American Board of Internal Medicine; Philadelphia, PA 19106Acknowledgments: The authors thank the American Academy on Physician and Patient and the Bayer Institute for Health Care Communication. Both organizations have helped the authors develop their skills in counseling patients and in teaching physicians these skills.Corresponding Author: Wendy Levinson, MD, University of Chicago Medical Center, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637; e-mail, [email protected]bsd.uchicago.edu.Current Author Addresses: Dr. Levinson: University of Chicago Medical Center, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637.Dr. Cohen: Section of Urology, Medical College of Georgia, Room BA-8408, Augusta, GA 30912-4050.Dr. Brady: Emory University, 69 Butler Street SE, Atlanta, GA 30303.Dr. Duffy: American Board of Internal Medicine, 510 Walnut Street, Suite 1700, Philadelphia, PA 19106. 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