Pic 0: The title card appears before returning to Dr. Owens.
Somehow, it can feel harder to tell a patient that they have a substance use disorder than to say they have diabetes, but really the conversations aren't that different. With a recovery focus, managing OUD is similar to managing any other chronic condition. Every physician has practice motivating patients to take medications and change their behavior to support their health. Of course, that's never as easy as it sounds!
Pic 1: The screen transitions to a visual of a patient’s chart with an image of a woman in the upper left-hand corner. It includes the following information:
Name: Lori Craig
Age: 32
Sex: Female
Ethnicity: Caucasian
Weight (lb): 130
Height (in): Five foot, three inches
BMI: 23.8
BP (mmHg): 120/70
Temp (F): 98.9
Occupation: Attorney
Education: Law School
Allergies: NKDA
Medication: 15 mg oxycodone
Smokes: Yes
Chief Complaint: Chronic thoracic pain
Last Visit: Routine visit 5 months ago
Dr. Owens: Today, you'll watch a care provider talk about opioid use with patient Lori Craig.
Pic 2: A text box pops up over the chart which reads “Prescription Drug Monitoring Program (PDMP): Second oxycodone prescription from a different doctor, 3 weeks ago.”
Lori is an attorney who has been taking oxycodone since a car accident two years ago. Her primary care provider just received her request for an early refill, the second in three months. But now his office has a new policy: to check the Prescription Drug Monitoring Program before refilling a prescription for a controlled substance.
The PDMP showed that Lori has filled prescriptions at multiple doctors. And her most recent urine test was positive for morphine and codeine as well as oxycodone. It's clear that she's misusing opioids to some extent.
Pic 3: The screen returns to Dr. Owens. A list appears next to her. The first bullet point has an image of two different kinds of pills next to it and reads “Evaluate for OUD.” The second has an image of a megaphone with sound waves coming from it next to it and reads “Build motivation.” The third has a medical cross next to it and it reads “Decide on treatment plan.” The last has a miniature check list next to it and reads “Plan next steps.”
In the provider’s conversation today, their goals are to evaluate Lori for OUD, build her motivation to reduce opioid use, and collaborate with her to decide on a treatment plan and immediate next steps.
To effectively navigate these goals, the provider will be using communication techniques that motivate Lori by showing her respect, eliciting her experiences and approaching her with empathy.
Pic 4: The screen changes to a title card that reads “Respectful Sharing of Information” with a word bubble that contains an information symbol next to it. After a moment, this fades and a new slide appears with two figures sitting in chairs, the left one gesturing towards the other. A word bubble appears from the gesturing figure’s head with a question mark inside it. At the top of the screen, the word “Ask” appears. After a moment, that word bubble disappears and a new one appears above the patient with an ellipses within.
To share information respectfully, the provider should try first asking for permission or asking what Lori already knows. Many patients are quite knowledgeable about their own conditions.
Pic 5: The patient’s word bubble disappears and a new one appears from the provider, with an information symbol in it. A hyphen and the word “Tell” appears next to “Ask” at the top of the screen. The provider’s word bubble changes to one with a question mark, and another hyphen and “Ask” appears at the top of the screen. The patient responds with another word bubble with an ellipses within.
Then, the provider can correct any misconceptions and share anything new, then follow up with a question to hear her reaction. This is called Ask-Tell-Ask.
Pic 6: The screen turns to a new one, titled “Ask-Tell-Ask.” A dialogue appears in messages between the provider and patient. The provider’s message has a word bubble with a question mark next to it.
Provider: What do you know about methadone?
Patient: Methadone? Isn’t that the stuff they give addicts? I’m not using heroin, just pills!
Pic 7: Another screen continues the conversation. The provider’s first message has a word bubble with an information symbol in it next to the words, and the provider’s second message has another word bubble with a question mark next to it.
Provider: Methadone is used to treat people with opioid use disorder who use heroin, that’s true. It is also used for treatment of opioid use disorder for people using opioid pills. It helps people by reducing cravings and allowing them to avoid withdrawal symptoms.
Provider: What do you think about that?
Patient: It would be easier to quit if I didn’t feel like death every time I try.
Pic 8: The screen changes to a new title card which reads “Open-Ended Questions” and has a series of three green word bubbles with question marks above it.
When taking Lori's history, Open-Ended Questions, which don't have a yes/no or one-word answer, can elicit more details and help the provider better understand her situation.
Pic 9: The screen changes to one that has examples of closed and open-ended questions, marked with either a red X or green checkmark.
Closed Question: Have you tried to stop in the past?
Open-ended Question: What happened the last time you tried to stop or slow your use?
Closed: In a typical week, how many pills do you take?
Open: Tell me about your opioid use during a typical week.
Closed: Do you think you’re taking too many pills?
Open: In what ways are you concerned about your use of opioids?
Pic 10: The next screen has the text “Showing Empathy” alongside a red word bubble with a white heart in it.
Patients with opioid use disorder face a lot of stigma and judgment. It's important to show empathy for Lori's situation.
Pic 11: The next screen has three categories at the top, “Affirmation,” “Validation,” and “Normalizing.” “Affirmation” is currently highlighted, and below is a list of example sentences, each with a little red shield next to it. One example sentence reads “I saw how hard you worked to get back on your feet after that car accident. You can get through this.” The other reads “It’s your choice what treatment to use. I know you’ll think carefully about what will work best for you.
Affirming the ways in which she is capable and successful helps her recognize she is strong enough to seek recovery.
Pic 12: Validation is now highlighted, with its own example sentences. Next to each is a red checkmark. One example reads “Taking opioids makes physical changes in your brain pathways. This is a situation where willpower might not be enough.” The other reads “Your cravings are part of a medical disorder. We have treatments that can relieve them.”
Validating that Lori's struggles are the result of a medical illness can help her feel less guilt and shame.
Pic 13: Normalizing is now highlighted, with two new example sentences. Next to each is an image of a thumbs-up. The first one reads “I’ve seen a lot of patients use medication as part of their recovery.” The other reads “Some of my other patients have found that counseling helps them develop coping skills to be able to better manage stressful situations.”
Normalizing that others have gone through the same thing and found recovery will help Lori feel capable of change.
Pic 14: The screen changes to a still scene of a man sitting across from a woman in an examination room. After a moment, text appears over the scene. The first line has a little word bubble with an information symbol next to it and reads “Respectful Sharing of Information.” The second has a word bubble with a question mark next to it and reads “Open-Ended Questions.” The third has a word bubble with a heart next to it, and reads “Showing Empathy.” Below this are three bullet points, which read “Affirmation,” “Validation,” and “Normalizing.”
Now, you will watch Lori's doctor, Gabriel Pasko, use these techniques to talk to Lori about her opioid use.
Pic 15: The screen returns to Dr. Owens. After a moment, a list appears next to her. The first bullet point has an image of two different kinds of pills next to it and reads “Evaluate for OUD.” The second has an image of a megaphone with sound waves coming from it next to it and reads “Build motivation.” The third has a medical cross next to it and it reads “Decide on treatment plan.” The last has a miniature check list next to it and reads “Plan next steps.”
When the conversation is over, we'll take a look at how the provider did using these techniques to evaluate Lori for OUD, build her motivation to reduce opioid use, and collaborate on a plan for treatment and immediate next steps.