Remember this part of the consultation is not all about referring to services it is about working with the patient to identify relevant goals:
"I will stop smoking by next June" or "I will think about stopping smoking by next June" or "I will try my best to smoke less" etc.
Patient not ready to change
Conversations to support change may last for many years. It is perfectly reasonable to suggest to the patient that they may not be ready to make changes, but they may wish to consider doing something, and perhaps they might want to talk about it next year
The practitioners key role is to ensure this decision is informed and thoughtful
A useful final question could be:
“What would need to happen for you to reconsider change?"
Reflecting the answer can help the patient to really hear what it is they are saying and to check they are comfortable with the decision.
Agreeing to discuss this issue further at another time is an acceptable goal.
Patient still unsure
The practitioners role is to support the patient to reflect on the issues discussed
Discussing the good and less good aspects of a behaviour or circumstance can help to distil the issues surrounding change and taking it home may generate more clarity.
Listening and re-enforcing change talk can help to tip the balance towards change in the future.