|The following article is part of conference coverage from the PAINWeek 2018 conference in Las Vegas, Nevada. Clinical Pain Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in pain medicine. Check back for the latest news from PAINWeek 2018.|
LAS VEGAS — Communication remains a significant barrier to success between health care providers and their patients. This is especially true and timely for pain specialists, as the opioid crisis has likely contributed to heightened caution with patients when doling out prescriptions for pain medications.
“We, as practitioners, can be mislabeled and misinterpreted, yet, we can do the same thing to our patients,” noted Michael R. Clark, MD, MPH, vice chair of clinical affairs at Johns Hopkins University School of Medicine in Baltimore, Maryland, when introducing the keynote lecture by Kevin L. Zacharoff, MD, FACIP, faculty at Stony Brook School of Medicine in New York, titled “Mistaken Identities: Addict? Clinician? Drug dealer? Manufacturer?” during the 2018 PAINWeek conference, held September 4-8, 2018 in Las Vegas.
According to Dr Zacharoff, communication barriers between clinicians and patients, as well as among other health care providers, can result in mislabeling and misidentification.
Communication is “the greatest tool in the health care practitioner’s toolbox,” he told the audience. A patient’s medical record should serve as a vehicle for communication, he said, noting that it is essential to avoid using jargon.
In addition, recognizing the emotional barriers that patients may carry can help avoid misidentifying them. “Ask [a patient] what scares them. Ask them if they are in an abnormal emotional state. See if there are any topics they don’t want to talk about, and figure out why. Anxiety is the product of uncertainty and powerlessness,” which are emotions commonly experienced by patients with chronic pain.
Being aware of reduced attention span, lack of interest, inability to focus, and fearfulness, are all essential to better understanding a patient’s current position, both physical and emotional. Looking out for alternate viewpoints, preconceptions, biases, and misguided expectations is also key to overcoming a patient’s emotional barriers.
“If you read [a patient’s] medical record before you actually see the person, you read the chief complaint, diagnosis, prior treatments, and you formulate an opinion about that person before you ever meet them…that’s an enemy, that’s misidentification,” he said. “You are labeling that person without being aware of the context.”
Clinicians should avoid trying to identify the type of patient that they are dealing with, and instead should seek to empathize — which is distinct from sympathizing — with them. Everyone carries biases based on previous experiences, whether it be regarding gender, race, ethnicity, socioeconomic status, etc., but doing so in a professional setting can cloud clinical judgement.
“As clinicians, we bring our personal beliefs about pain into the room when we see patients. We also bring our professional beliefs; our knowledge and personal beliefs about treatments. Patients also bring their personal beliefs about pain and medications, their emotions, and their own individual levels of motivation. They also bring with them their history of prior experiences. If we omit these factors, we run the risk of misidentifying patients.”
“My position for you is to try and see how, through communication, you can foster better relationships with your patients,” Dr Zacharoff told the audience. “You can both gather and provide information. You can facilitate decision-making, instead of making the decisions. You can promote healthy behaviors, and you can respond to the emotions that you probe for. And you might find that your dialogue with your patients might be different,” he concluded.
Clark MR, Zacharoff KL. Mistaken identities: Addict? Clinician? Drug dealer? Manufacturer? Presented at: PAINWeek 2018, September 4-8, 2018, Las Vegas, Nevada. Keynote presentation.
For more coverage of PAINWeek 2018, click here.