Sex and drugs: An interview about discussing sensitive patient topics
Dr Windel Stracener, a family practitioner for 22 years, discusses substance abuse, sexual activity, and other sensitive topics many clinicians do not ask their patients.
Many clinicians do not ask patients about sensitive topics, such as substance use/abuse or sexual activity during routine medical histories. One reason is that they feel uncomfortable or they do not feel adequately prepared to have these discussions (McBride, R. 2012). To shed light on this challenging topic, MPR interviewed Windel Stracener, MD, a family practice physician at the Wayne County Community Health Center, Richmond, IN.
Please tell us a little about your own background and work with patients.
I have been in family medicine for 22 years. For a while, I was a hospitalist but I am now practicing in a community health center. This gives me the opportunity to develop relationships with patients and their families, often several generations. These relationships can be very helpful in bringing up sensitive subjects because patients already trust you and know you have their best interests at heart and that the issues you raise are not being asked to belittle them but to offer solutions and help them avoid hospitalization or chronic diseases.
How do you discuss the subject of weight loss and lifestyle changes?
Patients must feel that you are empathetic and do not judge them. This is key not only to discussing weight, but to any subject that comes up. I always try to give honest, straightforward answers and make patients feel at ease.
When you are bringing up the issue of weight, it is important to do so in a broader health context. “I see from looking at your BMI that you've got some extra weight we need to deal with.” If relevant, you can explain how this affects the reason for today's visit. You can also explain the impact of extra weight on the heart, lungs, blood pressure, and renal system.
Patients should feel that you are a partner who helps them find a path in their health plan, which will make them more committed to the plan. You become a cheerleader to encourage success and urge them not to get discouraged when a plateau occurs.
It is also important to set realistic goals. I don't say, “You need to lose 110 pounds by the end of this year.” I say, “Your first goal is to lose 10 to 15 pounds. Great, you've lost 8 pounds, now let's see what we can do next.”