“The most exquisite pleasure in the practice of medicine comes from nudging a layman in the direction of terror then bringing him back to safety again.” Kurt Vonnegut, God Bless You, Mr Rosewater

I have had some amazing successes in motivating patients to change their behaviour using fear. I have never subscribed to the five-stage ‘readiness to change’ model.

If such a theoretical model ever existed outside the ivory tower, I would have to say that I just condense the first four stages. Precontemplation, contemplation, preparation and action can be reduced to one step by explaining the reality of the patient’s situation and telling them what has to be done.

No pussyfooting about.