Preparing people and organizations for the challenge of change

摘要

Change or die. Perhaps the ultimate of ultimatums. This is the choice physicians often must give their at-risk patients. Yet, even when advised that their quality of life and life expectancy may be dramatically reduced if they do not follow treatment guidelines, as few as one in four diabetic and cardiovascular patients will be able to adhere to medication regimens and recommended lifestyle changes (Jin, Sklar, Sen Oh, & Li, 2008; Julius, Novitsky, & Dubin, 2009). Physicians report a distinct group of patients who seemingly cannot quit tobacco use despite having experienced adverse health consequences. For example, there is the patient who had a myocardial infarction at age 37. Or the one who has severe compromise of the blood flow to his legs and feet, which can lead to amputation, yet continues to smoke despite the physician's best efforts to communicate, educate, and encourage discontinuation. Beyond the addictive powers of tobacco, there is great inertia within many smokers to undertake the difficult task of putting personal resources toward a total effort to quit. Indeed, some patients will tell their doctor they would rather "die than change." Change is hard. Change is really hard for patients.