List seven techniques to employ when discussing sensitive issues with patients.

Question

8. Describe how substance abuse can lead to mental health issues and vice versa.
Case Studies with Critical Thinking Questions
Scenario 1
Jerome comes into the clinic today to have his blood pressure checked. When going over his
history he starts to tell you that he is under a lot of stress at home and at work and sometimes
feels extremely overwhelmed. He seems embarrassed to talk about it but states he sometimes
feels like giving up.
1. What information do you need to gather from Jerome?
2. What resources are available to give Jerome?
Scenario 2
You are working with Dr. Ling and a 42-year-old male new patient comes in to talk about a
recent back injury that occurred. He tells you he had a tumble down the stairs a few days ago
and is now having a lot of pain in his back. He repeatedly tells you that he wants something
stronger prescribed like “oxys” for his pain, as he has been taking ibuprofen and it has been
ineffective. He denies using alcohol or any other substances, although you can clearly smell
alcohol on his breath and his speech is slurred. When you ask him to sign a release to get his
prior health care records transferred to your clinic, he states that he does not remember the
name of the clinic or physician he had seen in the past.
1. What might be going on with this patient?
2. What referrals or treatments may the provider indicate for the pAtients ?

Answer 1

Techniques for Discussing Sensitive Issues with Patients

1. Build Rapport: Establish a trusting relationship through active listening and empathy. This encourages the patient to open up about sensitive issues.

2. Use Open-Ended Questions: Encourage patients to express their feelings and concerns freely rather than limiting them to yes/no answers.

3. Practice Nonverbal Communication: Utilize appropriate body language, maintain eye contact, and demonstrate warmth to make patients feel safe and supported.

4. Create a Safe Environment: Ensure privacy and minimize interruptions to make the patient feel comfortable discussing sensitive topics.

5. Be Respectful and Non-Judgmental: Approach sensitive issues with sensitivity and avoid making assumptions or judgments about the patient’s situation.

6. Normalize Feelings: Help patients understand that their feelings are valid and common; this can reduce stigma and encourage openness.

7. Offer Resources: Provide information about additional support, such as counseling services or support groups, tailored to the patient's needs.

Substance Abuse and Mental Health Issues

Substance abuse can lead to mental health issues and vice versa in a reciprocal relationship.

1. Mechanisms: Substance use can alter brain chemistry and neural pathways that are crucial for emotional regulation and decision-making, potentially leading to anxiety, depression, or other psychiatric disorders.

2. Coping Strategy: Individuals with mental health issues may turn to substances as a form of self-medication to alleviate their symptoms, which can escalate into dependency and addiction.

3. Cycle of Abuse: As substance abuse worsens, it may exacerbate underlying mental health conditions, creating a vicious cycle where the person feels compelled to use more substances, worsening both their mental health and dependency.

Case Studies with Critical Thinking Questions

Scenario 1: Jerome's Case

1. What information do you need to gather from Jerome?

   • Obtain a detailed mental health history, including any previous experiences with anxiety or depression.
   • Assess the duration and intensity of his stress and feelings of overwhelm.
   • Inquire about any current support systems (family, friends, therapy).
   • Discuss any previous treatments or coping strategies he has tried.
   • Assess for any risk factors such as suicidal thoughts or self-harm.

2. What resources are available to give Jerome?

   • Referral to a mental health professional or counselor for stress management and coping strategies.
   • Information on local support groups for stress or mental health.
   • Educational materials regarding stress management techniques (e.g., mindfulness, relaxation exercises).
   • Potentially a primary care follow-up to monitor physical health, including blood pressure issues exacerbated by stress.

Scenario 2: Male Patient with Back Injury

1. What might be going on with this patient?

   • The patient may be struggling with substance abuse, particularly alcohol, given the smell of alcohol and slurred speech.
   • He may be attempting to manipulate the medical system to obtain prescription medications due to possible dependency on substances for pain relief.
   • Cognitive impairment may also be present, as indicated by the inability to recall past health care providers.

2. What referrals or treatments may the provider indicate for the patient?

   • Immediate referral to a pain management specialist or an addiction specialist to address both his back pain and potential substance abuse issues.
   • Assessment for alcohol use disorder and possibly a referral to an addiction treatment program.
   • Counseling or therapy options to help address underlying psychological issues related to substance use.
   • Follow-up appointments for continued assessment of his pain and mental health, incorporating a multidisciplinary approach if necessary.