In Part 1 of this post we discussed what keeps us as claims and healthcare professionals from discussing sensitive topics with our injured workers. In this post we will discuss a method to increase the accuracy and specificity of these conversations.
The National Institute on Drug Abuse developed an educational curriculum for medical students addressing how to discuss these sensitive topics. Following is an excerpt from this training:
Techniques that improve the quality and the specificity of the data reported by the patient by:
- Asking for facts rather than judgments
- Asking in specific rather than general terms
Techniques that decrease anxiety by:
- Preparing the patient or setting the context
- Normalizing by making the problem or anxiety a somewhat universal experience
- Using transparency telling why you need to ask about certain info
- Asking permission
- Option of not answering question
- Addressing confidentiality concerns
- Careful, mindful wording of questions
Using all Three Techniques Together (An Example)
- “I ask all my patients about their drug use as part of gaining their medical history (normalizing)
- …Because it can have an important impact on their overall health. (transparency)
- …Would it be OK if I asked you some questions about your drug use of both prescribed and recreational or street drugs?” (asking permission)
- Confidentiality concerns – Cannot promise patient 100% confidentiality – patients have a right to be informed about this.
Case Study Mr. S.
Mr. S is a 48-year-old positive drug and alcohol screen post-injury. His drug screen demonstrated opioids and marijuana. Mr. S reports chronic pain in his neck and shoulder along with his acute low back injury. Using the techniques detailed above you discern Mr. S states he uses these drugs on an intermittent basis to assist him in management of his chronic pain issues. He admitted at times he uses more of these drugs than he intended. Every time Mr. S is seen by the physician he reports pain of a level of 10/10, the NSAIDs do not alleviate his discomfort and requests a prescription narcotic pain medication.
After obtaining a full and accurate biopsychosocial history, you plan your upcoming visit with Mr. S by thinking through his goals of care and determining how you will facilitate his pain management needs. You spoke with the treating physician about your concerns, and set up a time for both you and the physician to sit down with Mr. S. You sought advice from a pain management specialist and communicated this information to the treating physician. With your encouragement, the physician was able to discuss with the injured worker his goals for treatment, the effectiveness of non-opioid alternative pain management regimens and establish boundaries. You were able to reinforce that you both believe he has legitimate pain issues and that the therapies you are recommending may not be exactly what he wants. Because of the rapport developed, the injured worker agreed to adhering to and giving this treatment regimen a chance.