Special Patients/Challenging Questions

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Special Patients

-Anxious patient: encourage discussion of feelings, ask causes of anxiety, give reassurance

-Angry

patient: stay calm, ask reason for anger. Wait time: I understand,

clinic crowded, many patients before you, unexpected delays, now your

turn, will focus on you/care for you

-Crying patient: I know you feel sad, would you like to tell me about it

-Patient in pain: "Is there anything I can do to help you feel more comfortable?"

-Patient

who can't pay for the tests or treatment: "Not having enough money

doesn't mean you can't get treatment", and possibly, "we can refer you

to a social worker who can help you find some resources"

-Patient

refusing questions/examination: explain importance of exam/question. If

refusal persists, document refusal and counseling

-Hard of hearing: face patient directly, speak slowly, sit next to good side, use gestures (lower pitch)

-Patient who doesn't know med names/names you don't recognize: ask for written list

-Phone encounter: press speaker button to begin/end, no physical exam in patient note (like peds)

Challenging Questions/Situations

-Before answering the question, you may restate to make sure you understand

-If you don't know the answer, say I don't know

-Concern

for abuse (if they ask why you are asking these questions) "I am

concerned about intimate partner violence, that your partner may be

harming you in some way. My goal is to make sure you're in a safe

environment and not being exposed to abuse"

Patient Belief/Behavioral Issues

-Impotence

(believing it's just old age): age may play a role, but there may be

other causes (HTN, DM, medications). We also have meds to improve

-Herbal

medicines: suggested for many diseases, safety may not be as well

known. Let me know the name of the med, I will check into potential

treatment role

-Fear of surgery: empathize, ask specific concerns

-Serious problem, going on a trip: find now, early detection/management

-"I did not understand your question," repeat slowly. If they still don't understand, ask specific parts they don't understand

-Late work up: I'm glad you sought treatment. We will do our best and hope for the best.

-Does

my insurance cover: not sure, but can refer you to social worker, we

can also write note indicating that ___ test is needed

-Person

wanting to return to a job that can negatively affect health:

unfortunately, work may worsen condition; prefer stay at home for now,

will write a note

-Worried pain will affect job: with your permission, would like to communicate with your employer

-Fracture: cast & PT

-Malingering:

"I know you're uncomfortable, but after examining you I haven't found a

condition disabling enough to keep you out of work. I will prescribe

some pain medication and exercises, but a big part of your recovery will

be continuing your normal daily activities

Disease-Related Issues

-HRT and breast CA: after 4 years of use, recommend for relief of hot flashes for a limited period of time

-Abx for a cold: side effects that may make you feel worse

-Mom with breast cancer: regular screening tests are important