As a physician, it's not
unusual to see patients
who are ambivalent about
changing their behaviour:
that is, they possess
conflicting feelings
on the issue.
The scenario you're
about to see is a perfect
illustration of how we
can sometimes want two
opposing things
at the same time.
The patient is a
40-year-old male attending
a follow-up on his
annual physical.
His high blood pressure
is not under control.
Test results showed mildly
elevated GGT, AST, ALT and MCV.
His doctor suspects alcohol may
be causing these issues.
Motivational interviewing
is an excellent way to
help patients address
alcohol misuse.
By using the 5As -
ask, assess, advise,
assist and arrange -
physicians are able to
better understand their
patient's drinking
behaviour and help
them recognize their
ambivalence to change.
In doing so, they are able
to come up with a plan of
action that works.
Hi Stéphane.
Hi.
How are you today?
I'm okay, how about you?
I'm good, and good
to see you again.
I wanted you to come back
to the clinic today to
discuss your borderline
blood pressure,
and also the results of
your most recent blood work.
Okay.
Was there anything you
wanted to say before we start?
No.
Alright.
The blood work results I
got today show that your
liver enzymes
are elevated.
This is usually caused by
your liver being inflamed,
and the most common
cause of this is alcohol.
Well, I don't
drink that much.
It can't be that bad.
If it's okay with you,
I'd like to get a better
understanding of
how much you drink.
Well, you know, I
just drink socially.
And when you say socially,
what does that mean to you?
Well, you know, I go to
the bar with buddies after
work and we have a
couple of drinks.
When you say drinks, what
kind of drinks and how
many do you drink?
Well, you know, when I go
to the bar, we - well I,
I take about four pints.
But on weekends, I drink
bottles, so, I don't know,
Saturdays I'll drink like
twelve and maybe six on Sundays.
Okay.
Have you ever tried to
cut down in the past?
Yeah.
Like last year, I stopped
for a whole month when my
mom was at the hospital.
Did anyone ever mention
about your drinking,
and does that annoy you?
Well, my wife does
whine because, you know,
she says I...
I stink like stale beer
and I snore a lot and that
I wake up too early,
and that bugs me.
Mm-hmm.
And have you ever felt
guilty about the amount
you're drinking or what you've
done while you were drinking?
No, never.
You know, I'm responsible.
Like I don't
really get drunk,
I don't get into fights, I
never drink and drive and
I never miss a day
of work, you know?
Like, it's not a problem.
Well that's really good.
Has it ever happened that
you've needed a drink or
medication to
start off your day?
Ha, no.
Like if I ever do, I'll
show up to detox right away.
Based on the information
you're providing me,
although it is clear to
me that you are not an
alcoholic, the amount
you're drinking is
concerning to me, and I
think it is the cause of
your inflamed liver.
I think it probably also
contributes to your poor
sleep, your snoring
and also why your blood
pressure medications
aren't working as well as
we would like them to.
Really?
Mm-hmm.
Would you be interested
in discussing ways to
decrease your drinking?
Sure.
Alright.
So could you think of some
ways you could reduce your
drinking by yourself?
Well, for one, I guess I
should stop going to the
bar, like, and when I want
a drink, I'll have to do,
like, club soda or a pop.
Mm-hmm.
And I could, like, it'd
probably be good if I do
walks at night, you know,
occupy my time a bit, yeah.
Mm-hmm.
And how about
on the weekends?
Well, on the weekends, I
could easily stop buying
beer for home because I'm
the only one at home who
drinks beer, so it
wouldn't be a problem if
there's no more.
And, you know,
talking to my wife,
she'll find stuff
for me to do.
She'll keep me
busy for sure.
These are great ideas.
Can you think of anything
that could impede you
decreasing your drinking?
Ah, well, my buddies for
sure won't be happy if I
don't show up to the bar,
so they'll try to get me
to continue going.
Hmm.
I have to say I would
advise you to stop
drinking entirely for
the next three months.
Completely?
Mm-hmm.
What do you make of that?
Well, it's not an
attractive idea.
But, you know, I don't
want to get cirrhosis.
Mm-hmm.
Well, if you stop now,
you would decrease greatly
your chances of developing
chronic liver disease.
Okay.
Alright.
Would you agree if I would
share some recommendations
with you?
Yeah, of course.
Alright.
So you could read
through that at home.
Okay.
It takes about three
months for all your blood
tests to come
back to normal.
But if it's okay with you,
I'd like to check in in
about a month to see
how you're doing.
Sure, that sounds fine.
Alright, okay.
So we'll see you
again in a month.
Thank you.