Tuesday, July 06, 2010

The "Think About It" Technique

Sometimes patients need some time to "mull" over things. And the idea of getting certain tests (i.e. colonoscopy) or starting certain medications (which they will have to take for the rest of their lives) is stressful to them. I have learned that for some patients, it is best simply to "bring up the idea" before prescribing an intervention. Here are some of the things that I might say:
Mr. Jones, at your next visit, we should schedule your screening colonoscopy. You've been putting it off for a while now.
Mr. Williams, the treatment of diabetes requires as least 4 different medications: your diabetic medication, something called an ACE inhibitor, aspirin, and a cholesterol medication called a statin. I'm telling you this now because I don't want you to be shock in the future. Today, we'll just start the metformin. As you come back, I'll talk to you more about the benefits of the other medications. 
Mrs. Stevens, your cholesterol is still really high. We should consider starting a cholesterol medication at our next visit in 3 months if it is still elevated.
Treating blood pressure frequently requires 3 or more medications. Most blood pressure medications at their maximum dose will only bring down your blood pressure by 15 points. So don't be alarmed if we have to add more medications in the future.
Guess what Mr. Reed, we need to do your rectal exam at our next visit!
Preparing patients mentally like this, especially for those who are typically against medical intervention, seems to "soften the blow" when the time comes. 


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