How can we find the patient within?

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 here 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 haven’t 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 do 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 there 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 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.

Linda Girgis is a family physician who blogs at Dr. Linda.

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