Friday, March 13, 2009

How not to normalize

Doctors have to deal with all sorts of challenging situations. For instance, you think that your patient might be suicidal. Broaching the topic with, "Hey buddy, do you have plans to kill yourself?" is really not going to make him/her want to open up. On the contrary, they're probably going clam up, bite their tongue, and make a beeline for the door.

Enter normalization. By generating a non-judgemental environment, the patient can then relax and feel at ease to confide in the doctor, who can subsequently endeavour to help them. For instance, "Sometimes, in these kinds of situations, people have thoughts about hurting themselves. Have you ever had these kinds of thoughts?" Tackling the problem from this angle assures the patient that A) you're not condemning them, and B) lots of people feel this way and they're not a super-freak.

Today we had a Clinical Skills session about dealing with "difficult patients." This encompasses everything from the patient who won't tell you anything to the patient that wants to rip your head off. In the former category, we had one standardized patient (actor) play out a scenario as a young, gay man worried that he had contracted HIV through unprotected intercourse. He presented with a "recurring cold virus" and was very hesitant to provide any information including the fact that he was gay, had had unprotected intercourse several times over a few months, and was afraid that he had HIV (though he had immediately demanded a blood test for his "cold").

During the debriefing, the group considered what strategies might have been effective in helping the patient to feel more comfortable and open up more readily. One group member suggested, "You could try normalizing. For instance, 'In this situation, people sometimes feel this way. Do you ever feel that way?'" I thought about this for a moment, trying to figure out how this would work in the given scenario...

"Sometimes, in these kinds of situations, people are gay. Are you gay?"

Hmm... Don't think that one is going to fly...

2 comments:

eleasa said...

what's the suggestion then?

a_ndy said...

The serious answer is that while the patient is answering questions reticently, there are generally clues over the course of the history. The attitude that was emphasized is not to make any assumptions. Therefore, when the patient gets to the point of talking about their "partner" or into their sexual history, it's advisable to clarify whether that sex is with men, women, or both without being judgemental. If you automatically assume that their partner is a "girlfriend" and speak to that, the patient is likely to clam up and the relevant information may be missed entirely.