| Patient Resistance Scenario |
Physician Response |
| Patient answers "no," seemingly without considering it thoughtfully or is reluctant to give details. |
- Gently probe with a question like: "Not even when you were in school?"
- Encourage discussion by saying "go on" or "tell me more."
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| Patient is uncomfortable disclosing personal substance use on a form. |
- Let the patient know you will follow up in person about the screening.
- Reinforce that all information provided will be kept confidential when possible.
- If patient is still uncomfortable, skip screening but provide information about harms associated with drug use.
|
| Patient appears ashamed or embarrassed about recommendations to change substance use behaviors. |
- State that this is a health-related medical recommendation and is not meant to judge or stigmatize them.
- Remind the patient of your role - that physicians have a duty to share test results with their patients.
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| At-risk patient appears ambivalent to the idea of changing his/her substance use behavior. |
- Acknowledge the patient's ambivalence and the fact that ambivalence is common.
- State your concern about specific ways that drugs may negatively affect your patient's health or personal life.
|
| Patient becomes upset, argumentative. |
- Do not argue with the patient. Give the patient time to make a decision (unless the condition is life-threatening).
- Discuss his/her concerns and reflect them back (e.g., convey that you understand the patient's claim that drugs make them feel better or that their peers use them).
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| Patient resists referral for additional assessment |
- Explore concerns about the assessment.
- Emphasize that referral for an assessment may not mean entering substance abuse treatment - and that treatment, if recommended, likely will include different options.
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| Patient cites barriers to attending the referral appointment. |
- Problem solve about barriers and offer support, such as reminder calls, assistance arranging transportation, and child care.
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| Patient resists the idea of going into formal substance abuse treatment. |
- Clearly state that you are not insisting on formal treatment.
- Explain that treatment is often easier than quitting "cold turkey" and that stopping the use of certain drugs (e.g., alcohol, benzodiazepines) without medical supervision can be dangerous.
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| In followup visits, patient shows no progress with change efforts. |
- Acknowledge that change is difficult.
- Repeat the brief intervention and discuss other ways to support the patient's efforts.
- Make additional referrals for patients who did not attend the referral.
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