Psychological aspects to handling the following situations:

1. Patient who needs referral for mental health care (easiest if px is depression or marital problems--not psychosis). For this role-play, the doctor should have seen patient for several visits already and noticed need during this time.

2. Patient who is suicidal.

--ask patient who is making direct or indirect suicidal statements:

--let patient know suicidal thoughts are an indication something needs to change

--let patient know that change is possible (even if it doesn’t look so now) with professional help

--insist that the patient see a counselor—have patient make appointment from your office

--schedule another appointment with the patient soon

--call patient to verify that they have kept counseling appointment

3. Ethical Situation: (such as pt. asking Dr. out)

--answer is no

--reason for the no is because of professional ethics (if dr. sees patient outside of clinic, that interferes with care—patients health is most important to the doctor). Use reasons of marriage, dating, sexual orientation as last resort.

--if this patient has been to see you for long time, let him/her know that sometimes it happens that when patients feel good about their care, they mistake the positive feelings for attraction, but "I would never take advantage of that because you and your health are so important to me.

--if patient offers to go to another doctor—no you will always be my patient to me.

--Continue to treat patient, but be careful to be professional at all times

4. Making outside referral because of lab or X-ray findings.

*Trick here is to motivate patient to go for further testing without scaring patient to death.

*Do not unless necessary tell patient all possible dx (esp. cancer, AIDS, etc) unless absolutely necessary or asked directly

*If there is a problem, and the patient knows what it is, he/she can get information and make the best decision about their care. Avoid discussions of how to treat a possible diagnosis.

5. Noncompliant patient

*Acknowledge that new habits are hard to implement

*Ask patient what is getting in the way of new habit (do not suggest reasons—wait for theirs)

*Ask patient what could help them stick to recommendations

*Let patient know how recommendations will benefit him/her and how outcome will be different if they don’t follow through (try not to use scare tactics or be too "parental"

6. Pt. who knows nothing about chiropractic and perhaps is there under duress or needing information

*avoid "sales approach"

*ask lots of questions

*find out why the patient is there and gear information to their specific problem (also let them know if that problem is usually helped with chiropractic treatment)

*find out how they heard of you and what they know of chiropractic (do not assume it is negative or that they have seen 20/20)

*with those their under duress offer to start the exam and take the "wait and see" if this will help, rather than very enthusiastic approach

*let results speak for themselves!

7. Pt. who wants to dictate treatment

*applaud patients knowledge of their body/treatment/chiropractic (even if a little misguided)

*verbally acknowledge what the patient is asking of you

*let patient know what your treatment plan is and why it may be differ from theirs

*Offer to refer patient to another doctor that may honor their wish (patient will generally not take this referral, but see you as someone who cares about him/her, not just $)

*Ask patient to try your recommendation for ____ weeks/visits

7. Pt. Who has been to a previous chiropractor (but the doctor moved or died or patient moved, etc. (especially if patient was very attached to doctor)

*If you knew doctor, say something nice

*Acknowledge patients high regard (I can tell you really liked Dr. ___, or Dr. ___ sound like a good doctor)

*Acknowledge that the patient seems to really miss Dr. ---- (if appropriate)

*Ask what type of treatment they received

*Avoid putting down the treatment even if it was questionable

*Let patient know you will work hard to live up to the example Dr. ____ set.

9. Pt who felt worse after last visit. Will be dealing with patient’s anger and fear. Need to deal with anger first before reassuring patient that they are not broken (fear).

*Let patient tell you how bad they feel

*Verbally and non-verbally acknowledge patients distress (helps with the anger)

(examples—wow—you couldn’t sleep—that sounds bad)

*Thank patient for telling you

*Let patient know that although the situation happens and no cause for alarm

*Let patient know how long they may be expected to feel that way

*Offer hope of how soon condition may improve

*Do not offer to change techniques unless you think absolutely necessary—this gives the impression you did something wrong.

10. Pt. impatient about the progress of treatment.

*Acknowledge patient’s desire to be better faster (is normal)

*Ask patient what he/she wants to be doing that he/she is not able to

*Point out progress (with physical ability or pain index)

*Normal to get discouraged

*Where appropriate, let patient know when you would refer to someone else and other treatment options