Whether based on a patient’s age, habits and demeanor or on a constellation of subtle symptoms, you may have nagging suspicions. But you don’t know quite how to bring it up. Patients have their awkward moments, embarrassment and fear. The situation is common. Significant health issues often remain hidden because important words between physicians and the people they treat are simply left unsaid.
This is often true of uncomfortable gastrointestinal conditions such as fecal soiling, incontinence and chronic constipation, particularly when elderly or other vulnerable populations are involved. If you suspect a patient may be suffering, how do you help break their silence?
Experts offer advice:
For many patients, disclosing personal, potentially embarrassing information to anyone—including a physician—is perceived as high risk. Use active listening skills to help build trust, demonstrate empathy and signal their concerns are important. Establishing eye contact instead of focusing on a computer screen and using positive, responsive body language helps to convey your involvement. Also helpful is reinforcing that all doctor/patient conversations are confidential.
If a patient begins to open up, don’t let awkward silences interfere with information flow. Move the dialogue forward with questions and reassuring statements. Remind patients that as a healthcare professional, you deal with a broad range of difficult situations, and almost nothing is new or surprising.
Letting patients know that many others—and other patients of yours, in particular—suffer from incontinence or related problems, will go a long way to relieve embarrassment and encourage patients to speak up. You might say, for example: “Some of my patients occasionally experience soiling or even incontinence as they age. It’s not uncommon. If this ever happens to you, I hope you will trust me enough to let me know. Today, there are many therapies that can help.”
A more direct variation of the above approach is informing patients that toileting problems are common among certain patient populations. You might then add: “So I have to ask, and I hope you won’t be uncomfortable—have you ever experienced problems like fecal soiling or incontinence?” With either of these approaches, you might include an anecdote about a patient—anonymously, of course—who suffered a similar problem and, after discussing it, received successful treatment.
Displaying information in your practice about fecal incontinence and related topics not only helps educate patients but also may be just the stimulus needed to help them broach the topic. These resources might include fact sheets, brochures, and an Internet resource list. Make sure to place literature in exam rooms where patients can review it privately and start a discussion if desired.
Providing patients with a resource for self-reporting on sensitive health issues enables them to acknowledge a problem in a less threatening and personal way than through a live conversation. A survey also gives physicians the context for discussing problematic findings and moving the patient along the road to recovery. Medspira’s Patient Gastrointestinal Health Survey (link) is available for download. Personalize it with your logo and practice information and distribute it to patients for completion at home or at the conclusion of their visit. It has proven to be a highly successful tool for many mcompass practices.
However, a problem is brought to light, acknowledging it is the first step toward a cure. Let patients know that many people have overcome significant gastrointestinal issues, including toileting and fecal incontinence, by taking advantage of today’s advanced therapies and working towards a cure. Provide an overview of these treatments, emphasize that they will be delivered in full privacy, are covered by insurance, and, for some patients, may result in improvements within a short time period.
Make sure to book a follow-up appointment before a patient leaves. Some people may have second thoughts about treatment when they reach home, and having a date on the calendar increases the likelihood of compliance and a return visit.
Read more about how to eliminate the mystery surrounding elimination and fecal incontinence.