MI Coding

Practitioner: Hi Bob, nice to meet you, I’m Stephanie.

Patient: Hi, hi, I’m pleased to meet you.

Practitioner: What can I do for you today? [Uh] What brings you here?

Patient Uh, I, well smoking or wanting not to smoke, I mean I, I have COPD, and, and I smoke, which is not a good combination so um, that’s, that’s kind of the pith.

Practitioner Okay so you know you need to quit smoking.

Patient: Uh yea, yea certainly I know, and uh the wife in no uncertain terms is telling me that I have to, I mean she’s the trigger for me coming here today. You know, just um she’s been uh truly impressive in her nagging. Supportive nagging but definitely nagging. So, but I, I, I know, I mean I just, I haven’t, I just haven’t been able to quit.

Practitioner: Well, have you ever quit in the past?

Patient: Not really, no, I’ve been, I’ve been, you know, since I got the, the diagnosis and, and, I’ve been trying to cut down and the, I’ve had a couple of exacerbations, one of them threw me in the hospital for 3 days. So that, that kind of scared me. So I’ve been, I’ve been trying to cut down but it, it just hasn’t been working. You know, go up and down and, triggers if I’m out and if at home I get, I get anxious, it just um, it just hasn’t been working.

Practitioner: Yea I mean quitting is really hard.

Patient: Well, yea, apparently so. Yea.

Practitioner: And everything can be a trigger.

Patient: Uh, yea, pretty well, pretty well. Yea which is not good, even no triggers can be a trigger. Cause yea, that’s your, you know, I’m thinking so much about not smoking, what am I thinking about smoking! So…

Practitioner: So what about distracting yourself, you know when you get these thoughts of smoking and then you think of smoking. I mean what about just distracting yourself all together?

Patient: Eee, I don’t think that’s really going to help because it’s not [pause] I, I smoke to give myself a little break to you know push the world back a bit, just like okay now I’m, I’m carving out a little moment for myself. Um so, it’s when I need to be away from distractions that I use it. You know, there’s like stuff, stress or whatever going on. So it’s a break from that, so I need [okay], I guess I need something that will give me that break.

Practitioner: Right so you don’t know how to take a break without smoking, So what about, mindfulness?

Patient: Mindfulness?

Practitioner: Yea or [is that] meditation or…

Patient: Oh, like doing nothing.

Practitioner: Yea [yea] the things people who don’t smoke do [they] to take a break. [Uh] like relaxation, mindfulness, listen to some nice music.

Patient: Yea I’m not, I’m not sure, that’s like sitting down and doing nothing as opposed to anything. I, I, I’m not sure that’s a positive thing. I always thought that was kind of new wave.

Practitioner: Okay so you’re not a mindfulness kind of guy. So what about uh video games? Like you do have a cell phone like an iPhone or Android you can keep yourself busy with video games.

Patient: So every time I want a cigarette I’ll play a video game? I, I don’t know. That just seems kind of juvenile actually. Um I am sure they are very intelligent cell phone games but I don’t know, I can look, I can look at some apps.

Practitioner: Yea, it’s not so much juvenile, it’s just sort of like ways to keep your hands busy. Like carrot sticks, or…

Patient: Oh I see…carrot sticks?!

Practitioner: Or celery sticks.

Patient: Okay…

Practitioner: You know the hand to mouth stuff because a lot of people too, it’s not just taking a break but its keeping their hands busy on a break, so I’m trying to give you some ideas of what you could do instead.

Patient: Vegetables.

Practitioner: Vegetables.

Patient: Okay [laughs] chocolate cigarettes, uh, there’s even bubble gum cigarettes, I remember. Uh I could, I could look at some carrots I suppose. Uh that seems, uh like it would be commented on in the general public but uh, well. Vegetables.

Practitioner: Well, what about nicotine replacement? I mean forgive me for not even thinking that sooner like [yea] what about the gum, the inhaler, the lozenge?

Patient: Umm I don’t know I mean, they, they, I figure they tend to be as expensive as cigarettes you know so there’s not financial incentive but you know just, you know, isn’t part of the idea that to get rid of the drug as well. You know it’s not, it’s not just the, the burning particles, but the, the drug. You know, that’s the addictive thing isn’t it? So you know if I’m going to quit shouldn’t I not have the drug?

Practitioner: I mean ideally. It’s nice that people can quit cold turkey but the reality is, less than 5% of people are able to do that on their own, so…

Patient: Less than 5%...that’s grim.

Practitioner: It’s not likely.

Patient: That’s grim [laughs].

Practitioner: Let’s get real about this whole thing and, and look at what’s going to make it more likely that you’re going to have success when we go for this quit attempt and nicotine really isn’t the problem, the problem is the way you’re get it. So, you know [yea] what about using an inhaler to give yourself some nicotine so you don’t have withdrawal when you quit and you can avoid smoking [mmhmm] until that becomes more of a habit, not smoking rather than smoking.

Patient: Uh, so I can, not have the cigarettes, have the nicotine and then after I feel better, then I can quit the nicotine.

Practitioner Yea, how does that sound?

Patient: Uh, sounds like a plan I guess.

Practitioner: Alright, I am going to make you a referral to my colleague. [Bob makes a series of muffled noises to try to interrupt the practitioner]

Patient: Okay, okay.

Practitioner: And uh, we can take it from there.

Patient: Okay.

Practitioner: Hi Bob, nice to meet you, I’m Stephanie.

Patient: Hi, hi, I’m pleased to meet you.

Practitioner: What can I do for you today? [Uh] What brings you here? Open Question

Patient Uh, I, well smoking or wanting not to smoke, I mean I, I have COPD, and, and I smoke, which is not a good combination so um, that’s, that’s kind of the pith.

Practitioner: Okay so you know you need to quit smoking. Complex Reflection

Patient: Uh yea, yea certainly I know, and uh the wife in no uncertain terms is telling me that I have to, I mean she’s the trigger for me coming here today. You know, just um she’s been uh truly impressive in her nagging. Supportive nagging but definitely nagging. So, but I, I, I know, I mean I just, I haven’t, I just haven’t been able to quit. Change Talk reason- The wife is telling me I have to” Change talk- Reason- “yea certainly I know” and said again, in the last sentence “I know” Sustain talk- “I haven’t been able to quit”

Practitioner: Well, have you ever quit in the past? Closed Question

Patient: Not really, no, I’ve been, I’ve been, you know, since I got the, the diagnosis and, and, I’ve been trying to cut down and the, I’ve had a couple of exacerbations, one of them threw me in the hospital for 3 days. So that, that kind of scared me. So I’ve been, I’ve been trying to cut down but it, it just hasn’t been working. You know, go up and down and, triggers if I’m out and if at home I get, I get anxious, it just um, it just hasn’t been working. Change Talk Mobilizing Change talk- Taking Steps- “since I got the diagnosis I’ve been trying to cut down” Preparatory Change talk- reason- has been hospitalized, due to COPD exacerbations, this was scary Taking steps- trying to quit, came to the appointment!

Practitioner: Yea I mean quitting is really hard.Complex Reflection

Patient: Well, yea, apparently so. Yea.

Practitioner: And everything can be a trigger. Simple Reflection

Patient: Uh, yea, pretty well, pretty well. Yea which is not good, even no triggers can be a trigger. Cause yea, that’s your, you know, I’m thinking so much about not smoking, what am I thinking about smoking! So…Ambivalence

Practitioner: So what about distracting yourself, you know when you get these thoughts of smoking and then you think of smoking. I mean what about just distracting yourself all together? Giving Information without permission Closed Question The Righting Reflex

Patient: Eee, I don’t think that’s really going to help because it’s not [pause] I, I smoke to give myself a little break to you know push the world back a bit, just like okay now I’m, I’m carving out a little moment for myself. Um so, it’s when I need to be away from distractions that I use it. You know, there’s like stuff, stress or whatever going on. So it’s a break from that, so I need [okay], I guess I need something that will give me that break. Sustain talk

Practitioner: Right so you don’t know how to take a break without smoking, So what about, mindfulness? Judgment Closed Question

Patient: Mindfulness?

Practitioner: Yea or [is that] meditation or…Closed Question

Patient: Oh, like doing nothing.

Practitioner: Yea [yea] the things people who don’t smoke do [they] to take a break. [Uh] like relaxation, mindfulness, listen to some nice music.Giving vague advice without permission

Patient: Yea I’m not, I’m not sure, that’s like sitting down and doing nothing as opposed to anything. I, I, I’m not sure that’s a positive thing. I always thought that was kind of new wave.Discord - They are not on the same page

Practitioner: Okay so you’re not a mindfulness kind of guy. So what about uh video games? Like you do have a cell phone like an iPhone or Android you can keep yourself busy with video games. Simple Reflection, Closed Question, Righting Reflex

Patient: So every time I want a cigarette I’ll play a video game? I, I don’t know. That just seems kind of juvenile actually. Um I am sure they are very intelligent cell phone games but I don’t know, I can look, I can look at some apps. Discord - He’s telling the therapist that her ideas are not helpful

Practitioner: Yea, it’s not so much juvenile, it’s just sort of like ways to keep your hands busy. Like carrot sticks, or… Discord

Patient: Oh I see…carrot sticks?!Discord

Practitioner: Or celery sticks.Giving Information

Patient: Okay…

Practitioner: You know the hand to mouth stuff because a lot of people too, it’s not just taking a break but its keeping their hands busy on a break, so I’m trying to give you some ideas of what you could do instead. Discord

Patient: Vegetables.

Practitioner: Vegetables.Simple Reflection

Patient: Okay [laughs] chocolate cigarettes, uh, there’s even bubble gum cigarettes, I remember. Uh I could, I could look at some carrots I suppose. Uh that seems, uh like it would be commented on in the general public but uh, well. Vegetables.

Practitioner: Well, what about nicotine replacement? I mean forgive me for not even thinking that sooner like [yea] what about the gum, the inhaler, the lozenge? Closed Question, Closed Question, Righting Reflex

Patient: Umm I don’t know I mean, they, they, I figure they tend to be as expensive as cigarettes you know so there’s not financial incentive but you know just, you know, isn’t part of the idea that to get rid of the drug as well. You know it’s not, it’s not just the, the burning particles, but the, the drug. You know, that’s the addictive thing isn’t it? So you know if I’m going to quit shouldn’t I not have the drug? Sustain talk

Practitioner: I mean ideally. It’s nice that people can quit cold turkey but the reality is, less than 5% of people are able to do that on their own, so…Giving Information – expert trap

Patient: Less than 5%...that’s grim.

Practitioner: It’s not likely.Simple Reflection

Patient: That’s grim [laughs]. Sustain talk

Practitioner: Let’s get real about this whole thing and, and look at what’s going to make it more likely that you’re going to have success when we go for this quit attempt and nicotine really isn’t the problem, the problem is the way you’re get it. So, you know [yea] what about using an inhaler to give yourself some nicotine so you don’t have withdrawal when you quit and you can avoid smoking [mmhmm] until that becomes more of a habit, not smoking rather than smoking. Giving Information, Expert trap, Closed Question

Patient: Uh, so I can, not have the cigarettes, have the nicotine and then after I feel better, then I can quit the nicotine.

Practitioner Yea, how does that sound? Closed Question

Patient: Uh, sounds like a plan I guess. Change talk – however the client is being polite – he is quite tentative

Practitioner: Alright, I am going to make you a referral to my colleague. [Bob makes a series of muffled noises to try to interrupt the practitioner]

Patient: Okay, okay.

Practitioner: And uh, we can take it from there.

Patient: Okay.