A patient is reluctant to share medical history. How can you advocate effectively for them?

It is important to take time to understand why the patient is reluctant to share information. Use open ended questions to invite communication. Listen. Provide support, understanding and encouragement- reassure the patient that their health and safety are priorities, and that this is a safe place to share information. If they choose to share, thank them for trusting you with their information and validate their feelings. Incorporate the patient's wishes into the plan of care. If they do not wish to share, be respectful. Do not manipulate, condescend or cajole. Leave the door open for further conversation. The patient is an essential component of the healthcare team and their input is invaluable. If appropriate, offer additional resources.

Building trust takes time and patience, but it is essential for providing effective advocacy and personalized care. So approach the patient with empathy, respect for autonomy and a commitment to confidentiality one can foster an environment where the patient feels safe and supported in sharing their medical history. Let the patient know that you are available to answer questions or address any concerns they may have throughout the process. If needed, provide them with meaningful resources or referrals to support services for their wellbeing. Avoid judgmental or dismissive remarks that may further deter the patient from opening up.

Listen, listen above all! Do not interrupt the patient, especially a patient who is reluctant! Make her/him feel heard. Only then start explaining and reassuring. The patient always tells you pertinent information regarding their mental health and their clinical condition. Once you understand that, you can formulate a quick plan on how to address it.

Meet the patient where they are at, whether it’s a person in recovery reluctant to discuss past trauma or drug use. Or a patient who feels let down by the health care system. Empathizing and meeting them at their level is a great place to start building that rapport

I have always found that sitting with the patient is very helpful. It demonstrates that I am there for them and this is our time, I don’t have one foot out the door. It also creates a space for open dialogue, not an uneven perception of power, as standing over a patient can sometimes do. I use a WOW/COW and bring the position/ height down to the level of the conversation but in an unobtrusive way. That being said, after introductions, I always ask the patient if it’s a good time to talk because these conversations can be quite lengthy. It may sound very basic but the patient is not going to be focused on the conversation when they need the restroom, and I didn’t bother to ask.

Layman language! The same way it took time to learn the fancy medical words that we use so often, it is important to relearn layman or simple language to communicate effectively with the patient. What you might think you explained so thoroughly to the patient is half or not understood by the patient, not because you didn't explain properly but because of language! For eg, terms like "hypertension" might be confusing for some patients, who would better understand if you simply say "high blood pressure." Also, know your audience. Different areas may have varying levels of health literacy. Some might find medical jargon understandable due to higher education levels/exposure; others might require clearer explanations using everyday language.

Avoiding the use of jargon and asking the patient if there was anything that is unclear to them or didn't understand. Be aware of your body language and expressions, be patient and non-judgemental.

Educating your patients is necessity when you ask their medical history. Patients sometimes simply don’t see the relationships or context that healthcare providers can see. For instance, patients don’t share their skin condition at an optometry office just because they don’t think they’re related to one another. However, when I explain the possibility of a relationship between one condition and another; let’s say, patients with rosacea typically have an issue with sebaceous glands (oil secretion control), and that can be one of the factors to lead dry eye syndrome, then they understand the importance of sharing their medical history even if they seem unrelated to that specialist visit.

Patients have to know and understand the importance of family history and how it can impact their healthcare. Physicians have to explain the importance in a way patients understand completely.

Help patients understand the importance of sharing their medical history and the consequences of not sharing to their care and outcome. Reassure patients that their medical history and records are safe and only those in direct care team will have access to be able to give them the necessary care they need for a better outcome.

Many patients are afraid to share certain parts of their medical history for fear of who has access to it. We talk about HIPPA, but most patients don’t understand how it can prevent others from sharing their information. It is the job of physicians to ensure patients understand what HIPPA is and how we are legally bound to keep their information private.

To help alleviate concerns in regards to patient privacy, we can explain the importance of HIPAA and how we uphold patient confidentiality in our practices. For instance, parents of the patients on my unit are asked for the last four of their child's MRN before giving any updates over the phone. Moreover, the parents have to specifically tell the providers if any family members are allowed to get health information/updates, ensuring that the patients' information is not shared with any unauthorized parties. Showing the patients and their families that we will always protect their private health information with ultimately result in good rapport and great trust.

Considering LinkedIn serves as a global platform for professionals, it would be prudent to inform patients about the relevant privacy legislation (e.g. PIPEDA in Canada, GDPR in the EU and UK, APPI in Japan, etc.) that pertains to their location. Citing HIPAA may lead to confusion for those outside the United States.

Providing a safe and secure environment for sharing is always helpful for building rapport with patients, however does not always mean that it is enough. At times we do need assistance from external services such as liason officer for a specific cultural groups to assist with communication, understanding of cultural norms and building relationships based on common ground. The use of external support services when dealing with cultural diversity can assist patients to feel safe, understood, respected and valued, potentially leading to greater patient engagement.

Podemos desenvolver um relacionamento com os pacientes e familiares. Coletar dados e acolher em suas particularidades sem expôr ou julga-los. Não há como fazer diferença no processo de cuidar se não trazermos o paciente para nós!

If a patient remains hesitant, explore alternative ways for them to share information comfortably. They might prefer providing a partial history or only details relevant to the current issue. Offer to be present during discussions with healthcare providers to ease their anxiety. Consider using written forms or digital submissions for those who find it easier to communicate in writing. Allow incremental sharing, addressing one issue at a time, to gradually build their comfort level. Telehealth consultations can also be less intimidating. The goal is to accommodate their comfort while still obtaining the necessary information for their care, ensuring they feel supported and understood throughout the process.

When referred by another provider, I found scheduling a call, from the provider, to discuss the client important and informative. Resources such as valuable time would allow for details the client may inadvertently miss during an initial assessment or screening. Talking points could be decided in advance to guide the discussion in a health care setting.

Shared decision making is the way to go. In the face of informed decision, when patients are given a sense of control over their own care, patient readily accept therapeutic procedure in spite of chances of survival.

In the NICU, we often have interdisciplinary family meetings to explain their child's diagnoses, prognosis, and possible treatment plans. Everything is explained in great detail, ensuring that the parents can have each of their questions answered leaving no stone unturned. By educating the parents, they leave the meetings with a greater understanding, which in turn gives them more confidence and empowers them to make the decisions necessary to treat their child.

Reassuring the patient that at the end of the day, their decision is what matters most. Informed consent should be provided and a collaborative decision with the patient's best interest should be reiterated. They need to feel that you are honest and are giving importance to their health and safety. At times, when patients are nervous or stressed, informing/reminding them that they should ask questions when needed and ensure that they fully understand what was discussed before they sign their consent as we are also their advocates is needed.

Healthcare in and of itself is complicated. Patients can feel overwhelmed keeping up with their own health, let alone convey this to their providers. Encouraging the patient to leverage technology can be a way to help. Nearly every patient has a smart phone now. Utilizing health apps, medication managers, and apps that link to provides can help empower patients to own their health and remove some of the stress.

Empowering patients and respecting autonomy are often neglected by front-line providers. Let's always remember that it is crucial to acknowledge that patients are ultimately the primary stakeholders in their health care decisions.

As a provider, being empathetic is the most crucial value that you can have. Patients can have very deep and dark history that hurt them to even just recall. Nobody knows the actual reasoning behind their reluctant behavior except the patients themselves. Try not to be pushy, and try your best to put yourself in their shoes. On top of that, proving them a different way to share their medical history could solve the problem. For instance, patients know that their emotions will explode and won’t be able to stop crying as soon as they start to talk about their medical history, and because of that, they prefer to share them via email or online form so that they can be their own safe place and cry if they need to when they recall their history.

Advocating effectively on behalf of a patient who is reluctant to share medical history should include all of the steps mentioned in the question accept collaborating with providers or any person for that matter without the patient’s consent.

I have had success with helping the patient to understand we share the same goal: the best thing for their individual health. Developing that goal together and working through the steps to achieve that goal brings in a component of all of the above. It may take time to get all of the information we want but when they know they are in control, trust and sharing can grow.

There can be many reasons why a patient might be reluctant. My advice is to take the time to get to know your patient. Beyond just getting the history meet the patient on a personal level and try to create a relationship. When patients are comfortable with you as a person they will be more engaged with you as a provider.

Validation serves as a tool to foster trust and rapport. Recognizing a patient's concerns or hesitations provides an excellent starting point for understanding their perspective. From there, we can draw a nexus to the reasons why sharing information is necessary, and reassure them about the protection measures in place to safeguard that information.