Physicians sometimes are reluctant to discuss controversial subjects with their patients. But these discussions become easier, and often produce better outcomes, when physicians explain why they are bringing up the subject, and try to understand the patient’s perspective on it.
These were among the conclusions to emerge from the session, “Communicating with Patients about Potentially Controversial Topics” at the American College of Physicians 2017 annual conference in San Diego. Physicians Alexandra Norcott, MD, chief resident in quality and safety at the West Haven, Connecticut, Veterans Affairs hospital, and Sima Pendharkar, MD, FACP, quality director in the division of hospital medicine at Mt. Sinai St. Luke’s hospital in New York, role-played two doctor-patient discussions—one involving guns in the home, and the other on medical errors.
The session was moderated by Carrie Horwitch, MD, FACP, clinical associate professor at Virginia Mason Medical Center in Seattle, Washington.
Regarding gun ownership, Norcott cited a 2013 ACP study to illustrate doctors’ hesitancy to bring up the topic with patients. The survey found that 85% of respondents felt that firearms was a public health issue. But 58% had never asked about the subject, and 77% had never discussed ways of reducing gun injuries or deaths.
The survey also found that 66% of patients think it’s appropriate for their doctors to talk about firearm safety. That compares to 81% who think use of seatbelts is acceptable as a topic.
“When you’re talking to patients about firearms safety, be respectful and really individualize your counseling,” Norcott advised. “Provide context, and explain why you’re bringing the subject up. Is it because you’re concerned about self-harm, or because there are children in the home? Providing the patient with that background information is very helpful.”
It’s also important to respect the patient’s autonomy and concerns about privacy. Even though all discussions are protected as part of the doctor-patient relationship, “we shouldn’t push patients to discuss the topic if they don’t want to.”