My medical student found it difficult to get any information from a patient. When she presented the patient’s medical history to me, she was quite flustered and did not know what to say. I went with her to talk to the patient and met the same wall. It is not always an easy task finding the patient within.
Often, when what a patient is saying doesn’t make sense or it is hard to get information from them, it is because they are there for an entirely different reason and are embarrassed to bring the subject to light. As with the patient I mentioned, another underlying problem was festering. And this patient would not share it in the presence of the student but rather waited until she left the room. The reason is not so important as the why of it all.
How can we find the patient within?
- First, we need to find patience. It is not easy revealing secrets or embarrassing medical problems to another person, yet alone one we only see when we need medical treatment.
- Reassure the patient that you heard it all before. Let them know they are not the first ones that are probably bringing the same problem to you. Even if it isn’t something you have seen before, don’t let the patient know that. If you don’t know how to help with what they are seeking, find someone who will. There is nothing wrong with admitting that we don’t have all the answers.
- Remind the patient that everything that he/she reveals to you remains completely confidential. Despite the fact that patients now sign myriads of HIPAA notices, many of them do not pay attention. Many of them will start talking when they are reassured no one else will know what they are sharing.
- Ask open-ended questions and let the patient explain the problem in their own way.
- If you have others in the room and you think the patient is not wanting to speak in front of them, ask them to leave, whether it be your favorite nurse or the patient’s own spouse.
- Ask the patient specifically what they want help with. Do not assume! A patient with erectile dysfunction may not automatically want Viagra but may be scared to death because their father died of prostate cancer.
- Be gentle and kind! Always, no matter what. Patients need to feel we care about them and that we are open to anything they may tell us. In regards to medical problems, we are often their only help.
While it is not always easy to get patients to reveal their concerns, it is very important to do so. In the age of managed care where assembly line medicine is rewarded, we will miss things if we do not slow down and open our ears. A patient with concerns should not be rushed out the door with an order for blood tests and a prescription for Omeprazole. This may be what the patient needs but we need to analyze all data. When the person sitting in front of us in the exam room is scared or shy, we must step up and find the patient within.
Copyright secured by Digiprove © 2016 Linda Girgis, MD, FAAFP
Be gentle and kind! Always, no matter what. Patients need to feel we care about them …”
Yes, we need to be reminded of this.
Often.
To “discover” the patient within, we need to listen.
And listening takes time.
Above all – care.
Thanks, Linda!
Dr. Linda: Although I can’t confirm the quotation, Dr. Wm. Osler supposedly said, “If you listen to the patient long enough, they will tell you what is wrong with them.” My corollary: “And if you ask them the ‘right’ questions AND listen carefully to their answers, they will tell you how to treat them.” Your post on kevinmd.com greatly summerizes the truth of these ahorisms. However, today especially patients cannot be certain we physicians are able to keep their revelations ‘private.’ Our EMR charts go to many, many non-physicians, non-nurses, Physicians and Nurses no longer involved in direct patient care…Information which we physicians could keep private are beyond our abilities to do so IF we enter it into our patients’ charts-The same was true with paper charts. Years ago I asked a long-term patient if she smoked cigarettes-She told me she ‘cheated’ on occasion, especially at parties. Unfortunately I wrote this informaion into her chart…Later, when she and her husband applied for Life Insurance, this entry almost caused her NOT to get the insurance policy. By then(~3years later)
she was seeing one of my colleagues.
Do you know of a mechanism using EMR’s, short of keeping private written or encrypted files on a flash drive?
You make a very good point. Records are not so private like they have been in the past.