Talking to Patients About Health Risk Behaviors (non-credit)

The following cases are modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you can see whether you answered correctly and read evidence-based information that supports the best answer choice. The questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the activity, there will be a short assessment based on the material covered.

After completion of the CME/CE, please visit the Patient Simulation to try out your skills and engage a sample patient with using Motivational Interviewing techniques while receiving real-time feedback.  To access the simulation, click on the link that will appear following completion of this activity.


Patient Headshot: Allen

Allen is a 44-year-old white man with an unremarkable history. He is married with 2 children—a daughter aged 7 and a son aged 10. He was recently promoted to a position in upper management of a marketing firm.

One morning, soon after work begins, he asks a coworker to drive him to the emergency department (ED) of the regional hospital, where he presents with intense crushing chest pains. During screening for health behaviors, he reports that he does not smoke, drinks 2 or 3 beers twice a week, and snorts cocaine once or twice a month. He plays friendly games of doubles tennis once a week with 3 male friends with whom he grew up.

Initial tests appear to rule out a myocardial infarction. His blood results are normal (cardiac enzymes not elevated), he has a normal electrocardiogram, and his chest radiograph is normal. His respiratory rate is slightly elevated, as is his blood pressure (168/96 mm Hg), but his pulse is regular. He does not undergo echocardiography. His temperature is normal (99.2ºF), he has no chills, and he is not coughing. The attending physician in the ED notes Allen is overweight (with a body mass index of 27 kg/m2).

Allen stays in the hospital for observation and is scheduled for a stress test. Allen's acute symptoms resolve by morning. His workup, including his blood test results and results from his stress testing, were all negative. However, his urine toxicology screen revealed cocaine. His blood pressure remains elevated and he is started on a diuretic (hydrochlorothiazide). The emergency physician tells Allen he is concerned that his elevated blood pressure and his chest pain are likely related and that his use of cocaine puts him at greater risk for cardiovascular disease. Allen is discharged, and his wife picks him up. He is instructed to follow up with his primary care provider (PCP) within the week.

It is now 1 week later. He was reluctant to make the follow-up visit with you, his PCP, but his wife was persistent and he agrees just to appease her. He is at a follow-up visit; you have just concluded the physical examination.

You (his PCP) review his discharge summary with him and note that his urine toxicology screen was positive for cocaine. How would you open this line of conversation using a motivational interviewing approach?
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