Half-Hearted
I have chosen an issue here very dear to me, and one that I will not address with my usually flippant writing style. As a physician, the pathophysiology of the heart has always interested me, and all the more so because my brother-in-law died of a massive heart attack a little over a year ago, at the ripe old age of 50 years. A lifetime of smoking was the major contributing risk factor to his demise. The short stick of smoking served no useful purpose than to exact a heavy toll on the heart and lungs of the guest of honor at a premature burial.
A patient’s insistence on smoking cigarettes is a behavior that can eventually lead to a forgone conclusion. Early exposure to what is called a well-conducted elicitation process, however, may avert that end. So, let me describe a tentative and prospective elicitation process that might have saved my brother-in-law’s life had it been implemented sooner.
Had my brother-in-law, who had smoked heavily for the last 30 years, been one of a small group of habitual smokers enrolled in an elicitation interview process, the positive (in his eyes) and negative attributes of smoking would certainly have been elicited from him, as well as a description of influential individuals in his life who would have either been for or against the importance of his behavior. A series of questions of the following nature, destined to elicit the positive or negative attributes of smoking, might have been asked of him. Does smoking make you feel and look more important? Does smoking relax your nerves and make you feel less anxious? Does smoking make coffee taste better in the morning? Does smoking help you to socialize and break the ice? Do you know that smoking is a major contributing risk factor to serious illness? Do you smoke to lose weight or curb your appetite? Have you ever tried to quit smoking? Is smoking an addictive habit or can you quit anytime? Is smoking expensive? Do you like the taste of tobacco?
The interrogation would not have ended there, either, as the social referents who might have influenced my brother-in-law’s decision to smoke would have been flushed out of the bush. Without pointing fingers, rekindling guilt, or eliciting an “I told you so,” those influential mouthpieces might have been my sister and his wife, who was a smoker also; I myself, who was vehemently opposed to smoking; my brother-in-law’s peers and football drinking buddies, who were known to “hoist and puff” a few; my brother-in-law’s personal physician, who knew that congenital heart disease and heart attacks ran in his family; my bother-in-law’s blue-collar coworkers, who fought boredom on the job via a convivial smoke; my brother-in-law’s favorite rock musician, who was both transgressive and a habitual smoker; and, finally, my mother, an ex-smoker, who frequently warned of the evils of smoking.
With my brother-in-law’s behavioral beliefs and subjective beliefs thus individuated, attention would have been turned next to control beliefs, or the environmental factors that might have made it easy or difficult for him to quit smoking. They were all too pervasive, and a direct frontal assault on the negative influences might have been warranted. To name a few of both the positives and negatives, they might have been listed as being surrounded by family and friends who smoke; radio, television, and newspaper antismoking campaigns; Hollywood movies portraying smoking as “cool;” and antismoking billboards, restaurant signs, and lighted written cues on airplanes.
My brother-in-law was nonetheless obstinate and hard-headed, and, while the elicitation interview and its discussion would have most certainly elicited some resistance in him, I cannot help but believe that in the long run, a significant amount of behavior modification would have occurred to open his eyes to the root causes of his smoking behavior and give him a fighting chance to live a long, productive life. As it was, he lived by the burning stick and died by the burning stick! His life was gone on February 1, 2008 in a puff of smoke, and, instead of cajoling the excesses of Memorial Day barbecues, I must shake my head and gaze at an empty place at the picnic table.
© 2009, Albert M. Balesh, M.D. All rights reserved.
In memoriam of Joseph Conway.
A patient’s insistence on smoking cigarettes is a behavior that can eventually lead to a forgone conclusion. Early exposure to what is called a well-conducted elicitation process, however, may avert that end. So, let me describe a tentative and prospective elicitation process that might have saved my brother-in-law’s life had it been implemented sooner.
Had my brother-in-law, who had smoked heavily for the last 30 years, been one of a small group of habitual smokers enrolled in an elicitation interview process, the positive (in his eyes) and negative attributes of smoking would certainly have been elicited from him, as well as a description of influential individuals in his life who would have either been for or against the importance of his behavior. A series of questions of the following nature, destined to elicit the positive or negative attributes of smoking, might have been asked of him. Does smoking make you feel and look more important? Does smoking relax your nerves and make you feel less anxious? Does smoking make coffee taste better in the morning? Does smoking help you to socialize and break the ice? Do you know that smoking is a major contributing risk factor to serious illness? Do you smoke to lose weight or curb your appetite? Have you ever tried to quit smoking? Is smoking an addictive habit or can you quit anytime? Is smoking expensive? Do you like the taste of tobacco?
The interrogation would not have ended there, either, as the social referents who might have influenced my brother-in-law’s decision to smoke would have been flushed out of the bush. Without pointing fingers, rekindling guilt, or eliciting an “I told you so,” those influential mouthpieces might have been my sister and his wife, who was a smoker also; I myself, who was vehemently opposed to smoking; my brother-in-law’s peers and football drinking buddies, who were known to “hoist and puff” a few; my brother-in-law’s personal physician, who knew that congenital heart disease and heart attacks ran in his family; my bother-in-law’s blue-collar coworkers, who fought boredom on the job via a convivial smoke; my brother-in-law’s favorite rock musician, who was both transgressive and a habitual smoker; and, finally, my mother, an ex-smoker, who frequently warned of the evils of smoking.
With my brother-in-law’s behavioral beliefs and subjective beliefs thus individuated, attention would have been turned next to control beliefs, or the environmental factors that might have made it easy or difficult for him to quit smoking. They were all too pervasive, and a direct frontal assault on the negative influences might have been warranted. To name a few of both the positives and negatives, they might have been listed as being surrounded by family and friends who smoke; radio, television, and newspaper antismoking campaigns; Hollywood movies portraying smoking as “cool;” and antismoking billboards, restaurant signs, and lighted written cues on airplanes.
My brother-in-law was nonetheless obstinate and hard-headed, and, while the elicitation interview and its discussion would have most certainly elicited some resistance in him, I cannot help but believe that in the long run, a significant amount of behavior modification would have occurred to open his eyes to the root causes of his smoking behavior and give him a fighting chance to live a long, productive life. As it was, he lived by the burning stick and died by the burning stick! His life was gone on February 1, 2008 in a puff of smoke, and, instead of cajoling the excesses of Memorial Day barbecues, I must shake my head and gaze at an empty place at the picnic table.
© 2009, Albert M. Balesh, M.D. All rights reserved.
In memoriam of Joseph Conway.
posted by Dr. Al at
5/23/2009 11:25:00 AM
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