Narrator: Watch what happens this time when the provider cues into what the parent is saying, empathizes with her situation, and attempts to work with the parent to find a solution that fits her needs.
Doctor: So I wrote a prescription for antibiotics for Aiden.
Mom: Okay.
Doctor: I did want to talk to you, though, I'm a little bit concerned looking through his chart at how many ear infections he's had recently and I, I noticed that you had checked the box that someone's smoking in the home so I was wondering if you can tell me a little more about that.
Mom: Well, it's just me and him and I do smoke. I try really hard not to smoke around him but I, I've been smoking for 10 years, except when I was pregnant with him, but, it, everything, it's so stressful being a single mom and, and my having a full-time job and so I was just, that's why I started smoking again.
Doctor: You have a lot of things going on and smoking's kind of a way to relax and de-stress.
Mom: Yes, yeah. Some people have a glass of wine. I have a cigarette.
Doctor: Sure. And it sounds like you're trying not to smoke around him. Why'd you make that decision?
Mom: I know it's not good for him. I mean I've read those things about ear infections and asthma and stuff and, and, but other kids have ear infections and their parents don't smoke.
Doctor: So on the one hand you're worried about how your smoking might be affecting him and on the other hand you're not so sure if it's really the smoking that's causing these problems.
Mom: Right. Yeah. I mean he doesn't have asthma. He, I don't, he hasn't had a lot of other problems that his other friends have, so. And I've thought about quitting before in the past but I just don't, I just don't see how it's possible right now.
Doctor: What made you decide to quit smoking when you were pregnant?
Mom: Well, he was inside me and we were sharing everything and I knew that he would get some of that and I didn't, I just didn't, didn't think I could live with myself if something happened to him.
Doctor: Right now, though, it feels almost too difficult to even manage or even to try.
Mom: Yeah. Exactly.
Doctor: How were you successful when you quit before?
Mom: I don't know. I, I think about it now I don't even know how I did it. I just, I just did it, you know? I just, I just couldn't imagine like him not being born or going into labor early and, and him having problems and stuff like that, all the stuff that they talk about with women who smoke. So I, that was just enough to, to say, okay, you know what? I'm, I'm not going to risk that. So.
Doctor: The risks were so scary then that you were able to stop.
Mom: Yeah.
Doctor: They don't seem as scary to you now?
Mom: No. I mean we're two separate people and like I said, I don't, I try really hard not to smoke around him. I'm pretty good about that. I, I don't let other people smoke around him. So I, you know.
Doctor: You're doing the best you can do.
Mom: Yes. Yeah.
Doctor: Okay, but it sounds to me, too, like part of you really does want to quit.
Mom: Yeah, I, I know that I need to and I, you know, keep, every new year I say, okay, this year I'm going to quit smoking, but then something happens and it, it just doesn't—
Doctor: It's on your to-do list, it just not making it to the top.
Mom: Yeah.
Doctor: If you did decide to quit, on a scale of 1 to 10, where 1 is not at all confident, you don't think you could do it, and 10 is you feel pretty certain that you could, where do you think you fall right now?
Mom: Probably like a 5, kind of in the unsure area. Like I know I've done it before so I know I can do it, but at the same time it just seems really hard.
Doctor: Sure.
Mom: And it's not the same situation.
Doctor: Well, what made you say 5 rather than 2 or 3?
Mom: I know, I know all the ways it's bad for me and I don't want him to grow up thinking that it's okay to smoke. I don't want him to, to use any kind. I don't want him to chew or, or anything like that. So I know I need to, especially before he gets old enough to understand what mommy's doing, but I just don't know if I can do it.
Mom: Okay, so it sounds like you have a lot of reasons why you'd like to quit, you have been successful quitting in the past, and right now you're just feeling a little bit hesitant about your ability to do it.
Mom: Yeah.
Doctor: Where do you think we should go from here?
Mom: I don't know. I, I'd like some help, I just don't know what kind of help I need, so.
Doctor: Sure, well if you'd be interested, that's something I can definitely talk to you about. There are a lot of new options that can actually help people be way more successful in their attempt at quitting. There's different medications you can try—
Mom: I don't like medicine.
Doctor: Okay. There's also a lot of support groups and classes that you can take where you have other people to go through with you and sometimes just having that support can be a big part of it, especially for people like you where smoking is such a stress reliever.
Mom: That sounds nice, but I'm not sure if I have the time for all that.
Doctor: Sure. It feels like something that would take a lot of time and maybe not fit into your life. I wonder if we could talk about some options that might fit into your life.
Mom: That would be really nice.
Doctor: Okay, well if you're willing, then, we could set up another appointment where you could come in and we could talk more about that.
Mom: I would like that. That would be great.
Doctor: Great.
Mom: Thank you.
Doctor: Sure.
Narrator: This time the provider had the same agenda—to talk to this parent about the dangers of second-hand smoke and to counsel her to quit smoking. However, this time the provider's focus was on the parent's own view of the issue. By giving the parent an opportunity to reflect on her situation, the provider was able to elicit reasons for change from the parent herself. There was no need to lecture or scold because the parent was making her own case against smoking. Many times our patients already have the information that we try to give them. What they really need is someone to listen to them and to help them sort out a plan that will fit in their life.
By accepting and respecting our patients, even with their faults, we communicate our genuine desire to help them make positive changes in their lives. During this interaction, the provider demonstrated that she understood the parent's struggle and that she still wanted to help. As a result, this single parent felt she finally had someone on her team. This increased both her interest and willingness to try working further with the provider to find a solution that would fit in her life.