Patient Instructions — MORGAN CAMPBELL

You are Morgan Campbell, a 47-year-old accountant. You had a heart attack 3 months ago and overall feel ok however people seem still quite worried about you and this is making you think about things. You are very active and go to the gym 5 times a week and previously had not seen a GP for 11 years. However you still smoke. You are smoking 15 a day and have done so for a long time. This is worrying your family and is making you think you may need to do something about this. However you know this is going to be tricky as you like smoking and it is part of your social scene. You don’t want your mates who also all smoke treating you differently when you meet up. Your partner has asked you to stop smoking as you have two young children.

Ideas: smoking is probably not good for your heart

Concern: you don’t know how to stop smoking or if you can

Expectations: have the opportunity to talk about it a bit more to understand more about it

You will not be expected to be examined and should come dressed as a 47 year old accountant.

Your demeanour is friendly and approachable. You should answer questions as they are asked i.e. if it is an open question then answer openly, if it is a closed question then please answer with a yes/no/maybe. Only give information when it is specifically asked.

Students have been trained specifically in motivational interviewing, a form of discussion with patients to encourage behaviour change from within the patient (as opposed to telling them what to do). This involves lots of open questions, reflections, and affirmations of positives. Students may also choose to use a ‘ruler’ tool – ‘on a scale of 1-

10, how likely/motivated are you to quit smoking?’ They may ask this twice – if they have used OARS (Open

questions, Affirmation, Reflective listening, and summary reflections) correctly you should indicate an increase in your motivation to quit.

Please be fairly succinct as the students only have 6 minutes for this.

Your opening statement should be “thank you for seeing me doctor, my family wanted me to make this appointment to discuss my smoking. I’m unsure what to do.”

Patient Script (Student may ask for permission to discuss smoking)

Current feelings about smoking

“Well I am thinking about quitting but all my friends smoke/it will be too difficult/I’ve smoked for so long/kids are stressful/need it to get through the day”

Haven’t previously tried to quit but seriously considering it now (make sure this is said so that student can answer Q1)

Reasons behind thinking about quitting/knowledge of benefits/drawbacks of smoking

“My partner has asked me to quit”

“I have two young children and I’d like to live to see them grown up”

Friend has cancer - Afraid of symptoms

Bad for health

Risk to my children

Worst thing to potentially happen if you quit smoking

Nothing bad

What can I do to help/what could you do to change?

Start with nicotine patches

Get family/friends involved in helping me

Ruler tool – on a scale of 1-10 how likely/motivated are you to quit OR how important is it for you to quit?

If asked twice and the student has displayed OARS, increase likelihood/motivation from 4 to 6