12_https://vimeo.com/109552200_smoking cessation 
gpt
Sarah, I'm so glad you came in for your well-woman exam today. I think we addressed a lot of your concerns. However, I would like to ask you more about your smoking. Would that be okay?
human
Yeah, I guess.
gpt
Okay. So about how much are you smoking over the course of a day? You had said it had increased over once or twice a day.
human
Yeah, um, normally, I'm smoking, you know, like once in the morning, uh, once during my lunch break and then in the evening maybe like five or six.
gpt
Okay. So about eight cigarettes. So over the course of a day, just under half a pack?
human
Yeah.
gpt
Okay. And that's changed over what period of time?
human
Um, honestly, it's probably been over the past year or so that I- I've been smoking a little bit more.
gpt
Okay. So over the past year, the smoking has increased. And that's been mainly in the evening?
human
Yeah. Um, I have a two-year-old son as I mentioned, so I try to never smoke around him. So I'm normally kinda waiting until he gets to bed.
gpt
Mm-hmm. Well, that's the time when you can relax and unwind.
gpt
Yeah, exactly. You know, I told you, my-my schedule is kinda crazy right now. I, um, I work full-time and I just started back at night classes. So, you know, all that combined, you know, I enjoy that time to myself in the evening.
gpt
Sure. Sure. Well, it's a time to relax and you've got a lot going on.
human
Mm-hmm.
gpt
So are there other things you do in the evening to relax?
human
Um, I mean, maybe I'll have like a drink or two.
gpt
Okay. A drink or two. So about how many drinks would you say you have over the course of a day?
human
Um, maybe like two max.
gpt
Two max. How many drinks would you say you'd have over the course of a week?
human
I don't know. I mean, I don't really get why you're asking me that. I mean, I just came here, you know, for a regular visit. I-I am not here to talk about my drinking.
gpt
No, I understand- I understand. And I'm certainly not here to tell you what to-to do, Sarah. I'm interested in hearing your thoughts and sharing some information with you, and what you do with that information is totally up to you. You've got a lot going on. You're a mother, you're working, you're going to school, and our healthcare team wants to make sure that you have all the resources available to you to meet your goals, including good health. And my job as your healthcare provider is to listen to you and to share information with you, including healthcare concerns associated with smoking and alcohol. Would that be okay with you?
human
Yeah, I guess.
gpt
Okay. Well, we do know that an increase in smoking and alcohol is associated with certain kinds of cancer; colon cancer, cervical cancer, breast cancer, lung cancer, and, um, also pancreatic cancer. It's also associated with liver and lung disease as well as heart disease, diabetes, and hypertension. So that's a lot of information, but I'm-
human
Yeah.
gpt
-interested in what your thoughts are, Sarah.
human
Well, I-I'm just kinda surprised because, I mean, I don't smoke or drink that much. And I mean, compared to people I work with, you know, I-I smoke a lot less, and I feel like I've actually been trying to keep it pretty low.
gpt
So you're consciously trying to cut back.
human
Yeah.
gpt
I have a readiness ruler in my pocket here, 0 means not ready to stop smoking at all and 10 means absolutely ready to stop smoking. Where do you see yourself on that scale?
human
Um, maybe like a five.
gpt
About a five. So you're halfway there. So why did you choose a five rather than a four?
human
Well, I mean, you brought up some kinda scary stuff like, you know, cancer risk or other things like that. And you know, being a mother, I-I don't want something to happen to me obviously.
gpt
Right. Well, that's a lot of information to think about. So given, the fact that these healthcare concerns are a possibility, and that you're worried about your family and you certainly have goals you want to succeed at, where are you in your consideration to making a change? In other words, what steps would you consider taking for this number to move closer to a 10?
human
Well, I mean, I could maybe try to cut back in the evenings a little bit.
gpt
Okay, great. Let's quantify that a little bit. So how many cigarettes would that be?
human
Well, right now, if I'm having like five or six, I could try to smoke three in the evening plus, you know, still the couple during the day.
gpt
Okay. So you-- that's cutting back quite a bit. That's a big step. So since we're kind of running out of time here today, I'm wondering if we could-- would be willing to come back in about four weeks to review this plan?
human
Yeah. Sure.
gpt
Okay, good. So we can go over your laboratory results at that time, as well as review your plan. Now, would you like some information on smoking cessation?
human
Yeah, I-I think that would be very helpful.
gpt
Okay. Well, I've got a brochure here and this has-- it's a really good brochure. It has some distraction techniques in it in case you get those nicotine cravings. So it's-
human
Mm-hmm.
gpt
-been helpful, um, in-- with patients before. I'd also like to ask you, would you be willing to see one of our counselors?
human
Well, what-what for exactly?
gpt
Well, Dr. Kirtley is one of our counselors and he is an expert in-- at discussing the association between alcohol and stress. I want to share something with you. The National Guidelines recommend that women have no more than seven drinks of alcohol per week to-to stay at that low risk level, to avoid the healthcare concerns that we spoke of earlier.
human
Mm-hmm.
gpt
You've indicated that your alcohol consumption is a bit higher than that, putting you at risk. So that's why I asked if you'd be willing to talk to Dr. Kirtley.
human
I mean, I would like to talk about, you know, my stress, but I'm still not sure with the whole drinking thing.
gpt
Certainly, certainly. I'm glad you're willing to talk to him. So before you leave here today, we'll, uh, stop by the scheduler's desk and make an appointment for you to see me back in four weeks, as well as the appointment with Dr. Kirtley. And that way, before you leave, you're all set. So do you have any other questions for me, Sarah?
human
I don't think so.
gpt
Okay. Well, it's very nice to meet you. I'll see you in a month.
human
Okay.