If you only have a few minutes with a patient with severe multiple trauma and acute respiratory failure…
Williams could have been advised to choose another title for the practice’s section about patients with an addiction.(1)
However, sadly this title is the reality, even in rich countries. A large randomized controlled trial to reduce intimate partner violence and heavy drinking just recruited 600 women (mostly poor, single, black and unemployed) in Philadelphia to compare a low-intensity intervention (20 to 30-minutes of motivational counselling during the emergency department visit plus a telephone booster at 10 days) versus “no intervention”.(2) Are we dealing with individual ‘bad habits’ and ‘meeting the wrong guy’ which only deserve a few minutes and if this is even too long and too costly, why not using an Internet-based intervention?
There is no robust evidence yet that brief interventions have efficacy for improving outcomes of patients with an addiction.(3) In fact, as for many patients with other conditions, multi-factorial and repeated interventions, social and medical, with long-term follow-up are mandatory.(4,5)
Last, empathy relies on a very effective method, the basis being motivational interviewing. It includes reflective listening, reinforcing the patient’s own expressions of problem recognition or concerns, and affirming the patient’s freedom of choice. Several skills are pivotal: be open and listen; remove barriers; let the patient explain; share authority; be committed.(6) Time is the cornerstone for this. Fast medicine is an oxymoron.
1 Williams SD. If you only have a few minutes with a drug addict. BMJ 2015;351:h4211.
2 Rhodes KV, Rodgers M, Sommers M et al. Brief motivational intervention for intimate partner violence and heavy drinking in the emergency department: A randomized clinical trial. JAMA 2015:4;314:466-77.
3 Glass JE, Hamilton AM, Powell BJ, Perron BE, Brown RT, Ilgen MA. Specialty substance use disorder services following brief alcohol intervention: a meta-analysis of randomized controlled trials. Addiction 2015;110:1404-15.
4 Sussman JB, Kent DM, Nelson JP, Hayward RA. Improving diabetes prevention with benefit based tailored treatment: risk based reanalysis of Diabetes Prevention Program. BMJ 2015;350:h454.
5 Baumann S, Toft U, Aadahl M, Jørgensen T, Pisinger C. The long-term effect of a population-based lifestyle intervention on smoking and alcohol consumption. The Inter99 Study - a randomized controlled trial. Addiction 2015. Online Jul 14. doi: 10.1111/add.130522010;340:c1900.
6 Braillon A. The Good, the Bad, and the…Empathic. Am J Med 2015;128:e27.
Competing interests:
No competing interests
30 September 2015
Alain Braillon
senior consultant
Charlotta Pisinger (2), Françoise Taiebi (1) (1) University Hospital. 80000 Amiens, France. braillon.alain@gmail.com. (2) Research Center for Prevention and Health, Capital Region, Center for Sundhed, Glostrup University Hospital, Glostrup, Denmark.
Rapid Response:
If you only have a few minutes with a patient with severe multiple trauma and acute respiratory failure…
Williams could have been advised to choose another title for the practice’s section about patients with an addiction.(1)
However, sadly this title is the reality, even in rich countries. A large randomized controlled trial to reduce intimate partner violence and heavy drinking just recruited 600 women (mostly poor, single, black and unemployed) in Philadelphia to compare a low-intensity intervention (20 to 30-minutes of motivational counselling during the emergency department visit plus a telephone booster at 10 days) versus “no intervention”.(2) Are we dealing with individual ‘bad habits’ and ‘meeting the wrong guy’ which only deserve a few minutes and if this is even too long and too costly, why not using an Internet-based intervention?
There is no robust evidence yet that brief interventions have efficacy for improving outcomes of patients with an addiction.(3) In fact, as for many patients with other conditions, multi-factorial and repeated interventions, social and medical, with long-term follow-up are mandatory.(4,5)
Last, empathy relies on a very effective method, the basis being motivational interviewing. It includes reflective listening, reinforcing the patient’s own expressions of problem recognition or concerns, and affirming the patient’s freedom of choice. Several skills are pivotal: be open and listen; remove barriers; let the patient explain; share authority; be committed.(6) Time is the cornerstone for this. Fast medicine is an oxymoron.
1 Williams SD. If you only have a few minutes with a drug addict. BMJ 2015;351:h4211.
2 Rhodes KV, Rodgers M, Sommers M et al. Brief motivational intervention for intimate partner violence and heavy drinking in the emergency department: A randomized clinical trial. JAMA 2015:4;314:466-77.
3 Glass JE, Hamilton AM, Powell BJ, Perron BE, Brown RT, Ilgen MA. Specialty substance use disorder services following brief alcohol intervention: a meta-analysis of randomized controlled trials. Addiction 2015;110:1404-15.
4 Sussman JB, Kent DM, Nelson JP, Hayward RA. Improving diabetes prevention with benefit based tailored treatment: risk based reanalysis of Diabetes Prevention Program. BMJ 2015;350:h454.
5 Baumann S, Toft U, Aadahl M, Jørgensen T, Pisinger C. The long-term effect of a population-based lifestyle intervention on smoking and alcohol consumption. The Inter99 Study - a randomized controlled trial. Addiction 2015. Online Jul 14. doi: 10.1111/add.130522010;340:c1900.
6 Braillon A. The Good, the Bad, and the…Empathic. Am J Med 2015;128:e27.
Competing interests: No competing interests