'The Facts Concerning the Recent Carnival of Smoking in Connecticut' and elsewhere

Article Abstract:

Using a story by Mark Twain, 'The Facts Concerning the Recent Carnival of Smoking in Connecticut', the authors stress the importance of involvement by health care practitioners in their patients' efforts to stop smoking. The story contains a conscience in the form of a dwarf, a rebellious tendency in the narrator, and an authoritative aunt who nags the narrator without mercy. Health care workers often function as authority figures, and most smokers wrestle daily with their consciences. Moreover, virtually everyone has a rebellious streak. Self-determination theory is an approach to motivation that uses the dynamics that appear in Twain's story, with the inclusion of the 'growth-oriented self' (that underlies healthy development). The theory states that people have a need to be self-determining and are by nature internally motivated. Such motivation can be enhanced when others (parents, teachers, physicians) support one's self-initiation. Health care practitioners can promote internal motivation in their patients, not by directing or controlling them, but by allowing them to make choices. A review is presented of the medical literature concerning the application of self-determination theory to health care. As many as 95 percent of the 33 million people who stopped smoking between 1964 and 1982 did so on their own; smoking cessation programs have a low success rate (less than 10 percent). Three questions can be asked that focus the patient's attention on the possibility of stopping, while allowing him to decide whether to try. They are: "What do you understand about the health consequences of smoking?'; "Are you ready to quit?"; and "What would it take for you to stop smoking?" The last question probes the patient's personal reasons for stopping: it is the most important question. The questions should be asked in a noncritical way that clearly supports patient autonomy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Methods, Smoking cessation programs, Smoking cessation, Smokers, editorial

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Presenting the Facts About Smoking to Adolescents

Article Abstract:

Students who are presented an autonomous choice to stop smoking do not seem to be more motivated to stop, but are more successful in terms of actually stopping smoking than those who are given a fear-laden message of disease and death. A total of 154 teenagers at a suburban high school were divided into two groups, each of which heard a different presentation on National Smoke Out Day. Eighty students heard a presentation stressing that stopping was their choice, an autonomous decision to make. The other 74 students received a presentation featuring demand and fear as motivating reasons.

Smoking and youth, Youth smoking

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The importance of supporting autonomy in medical education

Article Abstract:

Giving medical students more autonomy in their education may make them more humane without detracting from their clinical competence. More humanistic doctors, in turn, will create more satisfied patients and even more positive health outcomes. Research in motivational psychology reveals that more humanistic educational methods can turn out more humanistic students. One component of humanistic training is to give students more control over their education.

Analysis, Innovations, Medical students, Education, Autonomy (Psychology), Medical education

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