Discussing an addiction affecting your patient’s health is stressful to both – your patient & you! Most people with addictions are aware it’s a problem. If you approach it with a finger of disapproval, criticism or blame pointed to them, you will push them into defensive mode and close their minds to suggestions. This isn’t necessarily taught in school, I made plenty of errors at the start of my doctor life.
I now use a logical 5-step process to initiate such difficult but crucial conversations, build a rapport with patients & discuss addictions without sounding judgemental, patronizing or aggressive. Also, the best part: it does not stress me anymore!
- Permission: “Is it ok to talk about your smoking habit ?”
- Insight: “Do you think it’s creating problems in your daily life & health?
- Inquiry: “What made you get started?”, “Tried quitting?”, “What makes it hard to quit?”
- Retrospection: “If you had a chance to restart, would you choose differently?”
- Recognize: “Such habits are very tough to break, that’s their nature – and stresses in life don’t help – but I believe you can do it and I would love to help you”
I then offer to refer them to state programs or to consult an in-house chemical dependency advisor or even a psychologist and discuss meds that could help – this line of approach gets them more willing to try them!
This approach is useful for all types of addictions ( Smoking, Alcohol, Recreational Drugs, Carbs, etc ) – BUT I avoid the word addiction! This isn’t some sneaky “gotcha” way to address the issue but is rather based on principles of respect & empathy while offering them a constructive way to help them genuinely.
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