• Patient counseling: Process of providing information, advice, and assistance to patients to improve their health, treatment adherence, and quality of life
• Patient-centered approach
  • Focuses on open communication between the patient and the provider, shared decision-making, and a shared goal of alleviating discomfort for the patient.
  • Takes into account patients’ individual preferences, concerns, and emotions
• Transtheoretical model of behavioral change: a biopsychosocial model that focuses on intentional behavior change of the individual
  • Assesses an individual’s readiness to modify a certain behavior
  • Provides strategies to guide the individual, e.g. in overcoming substance addiction, managing weight, adhering to medication
  • Stages of behavioral change in a patient:
    • Precontemplation: no awareness that problem exists
      • At this stage, physicians should ask open, probing, and nonjudgmental questions that explore the patient’s perception of the situation.
    • Contemplation: aware of problem but not willing to change yet
    • Preparation: preparing to make a change
    • Action: behavior is changed
    • Maintenance: behavioral changes are maintained
    • Relapse (not obligatory): behavioral changes are reversed

• Counseling on smoking cessation
  • Five major steps to intervention: “5 As” approach (“Ask, Advise, Assess, Assist, Arrange”)
    • The clinician should:
      • Inquire about and document use of tobacco (“Ask”)
      • Urge quitting with clear and personalized language (“Advise”)
      • Assess patient willingness to quit (“Assess”)
      • Provide resources to aid quitting (“Assist”)
      • Schedule regular follow-ups (“Arrange”)

Smoking is the single greatest preventable cause of death worldwide, regardless of age at quitting or the number of previous pack years.

• Counseling on alcohol abuse
  • A set of strategies to encourage patients to reduce alcohol consumption:
    • Provide feedback regarding the patient’s alcohol consumption and engage the patient in a conversation using reflective or motivational listening.
    • Inform about psychosocial support groups (e.g., Alcoholics Anonymous)
    • Inform patient about pharmacological treatment options (e.g., naltrexone, disulfiram)
  • Assess the patient’s readiness to change (transtheoretical model) and schedule regular follow-ups.
• Counseling on illicit drugs
  • A set of strategies to encourage patients to stop using illicit/recreational drugs:
    • Assess the patient’s readiness to change (transtheoretical model) and schedule regular follow-ups.
    • Engage the patient in a conversation using reflective or motivational listening (a technique in which the topic is broached by repeating or rephrasing the patient’s own words, and using open-ended questions).
    • Provide feedback regarding the patient’s drug consumption.
• Counseling on the use of prescription opioids
  • A set of strategies to counsel patients on the risks of opioid therapy:
    • Inform about the possibility of overdose, addiction, and adverse effects.
    • Stress that patients should not use someone else’s opioids.
    • Establish specific “SMART” goals (Specific, Measurable, Attainable, Relevant, Time-limited) for opioid therapy.

• A set of strategies to support patients that may be victims of intimate partner violence (IPV):
  • Express empathy, validation, acknowledgment, and nonjudgmental support after a disclosure of IPV.
  • Assess the patient’s willingness to take action and evaluate whether the patient is presently safe.
  • The patient should be referred to a social worker or domestic violence advocate/hotline to receive advice about preparing a safety plan.

Clinicians should not encourage the patient to leave their relationship but should support them if they come to that decision on their own.

• A set of strategies for reducing feelings of isolation, frustration, and hopelessness that can be present in patients with chronic diseases:
  • Emphasize that the patient is not alone and offer referral to support groups.
  • Listen to the patient’s frustrations and challenges and empathize with them. Do not dismiss their concerns.
  • Avoid platitudes such as “everything will be OK” or “I’m sure you’ll feel better soon.”
  • Discuss why treatment adherence is important for slowing/reversing disease progression.
  • Counsel on lifestyle modifications that may improve mood.

• Counsel patients with mononucleosis to avoid:
  • Strenuous physical activities for at least 21 days after initial symptoms develop
  • High-contact sports (e.g., football, wrestling) for at least 4 weeks because of the risk of splenic rupture.

• A set of strategies for reducing the risk of sudden infant death syndrome while the baby is < 1 year of age:
  • Counsel patients to always place babies on their backs on a firm surface for sleep.
  • There should be no pillows, loose bedding, or blankets in the crib.
  • The baby should sleep in the same room as the parents but not in the same bed.
  • Encourage mothers to breastfeed as long as possible and to avoid exposing the baby to cigarette smoke.
  • Use of a pacifier can also reduce the risk of SIDS.