Page 45 - Delaware Medical Journal - May/June 2020
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PRACTICE MANAGEMENT
HOW TO CREATE SPACE FOR DIFFICULT CONVERSATIONS
Every practice is different, and how much time you need for each patient depends of course on how work is distributed between you and your medical assistants, and how complex the patient’s needs are, Rattay notes. However, scheduling half an hour should allow for “a good, non-rushed discussion” with most patients, she says.
Some of
the more sensitive subjects you may
want to bring up, especially sexual and gender identity, can be complicated by
a staff member’s value judgments. “It’s important that we check in on our own values and understand if that’s going to impact interactions with our patients,” says Rattay. “Racial and sexual minorities feel discriminated against in the health care system. That impacts care, it impacts relationships, it impacts whether people are going to return.”
“Many practices are finding that medical assistants can easily be trained to
do the screenings in these different areas, and if something is flagged as a problem or concern, then the provider can hone in on that,” Rattay says.
You don’t want a patient’s visit to go off the rails when you broach a sensitive topic, so get the patient’s buy-in first. Rattay suggests starting off like this: “I’m going to spend a few minutes asking you some questions that we use with all of our patients to better understand your health. Is that OK?” Also let patients know the topics you’ll cover, such as emotional stressors, substance use, and sexual health.
You already ask your patients about smoking and drug use, but you may not be getting at some of the underlying issues, says Fink. For example, a patient may not interpret a question
about drug use to include prescription painkillers or marijuana, he notes. Consider asking these questions in different ways, such as “Do you take non-prescribed meds? Do you use any substances? Do you smoke anything?”
Some traditional cisgender patients may be offended
if you ask them about their sexual
or gender identity, says Fink. So let patients know that these are questions you ask all patients to make sure their needs are taken care of.
When a patient shares a challenge related to any of the subjects above, you want
to be ready with a next step, Fink says. Say your patient lacks access to healthy food or is at risk for a sexually transmitted infection. Where do
you send them? For a list of helpful resources, see sidebar on page 140.
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