13 Jul Keeping The Door Open
The exam room was quiet as the nurse took my blood pressure during my annual physical. It was so quiet that I could hear the patient speaking in the next room.
“I don’t want to talk about quitting smoking,” the man said angrily. “You should know that my whole family smoked like chimneys and lived well into their 90s! In fact, my great grandfather is still alive at 102 and he smokes three packs a day!”
I tilted my head slightly, trying not to be too obvious while eavesdropping on this conversation. I was quite interested in what the doctor would say next.
“Well, I’ve explained why this is important and how we can assist you in quitting. However, if you’re not ready, you’re right—there’s not much else to discuss,” sighed the doctor.
I heard the door close firmly as the doctor left the room.
A few moments later, I heard the patient leave. This time, the door slammed harder.
The exchange is familiar. Whether the discussion is about smoking, adopting healthier eating habits, exercising regularly, adhering to a medication regimen, or modifying any other behavior, there is a predictable rhythm to a conversation when a person who doesn’t have any intention of changing their behavior meets someone intent on pointing out the problem and the need for action.
‘Yikes, that guy is not ready to quit,” commented the nurse as she removed the blood pressure cuff from my arm. It seemed we had both been listening to this conversation.
And it was true—the patient certainly was not prepared to quit. But what struck me was that the doctor also seemed unprepared to talk with someone who didn’t have any intention of changing. The doctor came armed with solutions and answers to help the patient take action, but when that approach was met with defensiveness from the patient, the doctor concluded that the patient lacked motivation and readiness and gave up. The door to the conversation closed.
Helpers don’t have to wait until someone’s “ready” to be helpful. In conversations about change, there are effective ways to approach and support people who aren’t ready—yet.
Motivation and readiness to change are not fixed, static traits; rather they are dynamic processes influenced by interactions with others. If we find ourselves in a conversation with someone who isn’t intending to change their behavior, it is our approach to helping that makes a difference in whether the person becomes engaged and willing to continue the conversation.
We do this by respecting where the person is in their readiness to change and seeing our role as one that helps to enhance motivation for change instead of blaming the person for not having enough of it.
Because when it comes to readiness, so often it’s us—the person trying to help—who struggles with knowing how to keep the door to change open.
*The sad news of Dr. James Prochaska’s passing (1943-2023) was on my mind as I thought about what to write this week. As I sat in the exam room and overheard this exchange between a doctor and patient, I recalled Jim’s wisdom that it’s often the health professionals who are not ready for those in the precontemplation stage. May we all work to honor Jim’s memory by living as he did, meeting people where they are and helping them work toward happier and healthier lives.