When attempting to identify an at-risk patient in the E.D., there are a few techniques to encourage a patient to open up to you. Here are three important techniques to remember:
You might have considered making small talk to ease into the conversation, or empathizing with the patient by saying something like, "I understand." Making small talk may take too much time, but could be useful when speaking to an adolescent. Telling the patient you understand may provoke a defensive response like, "You have no idea what I'm feeling!"
The first step is to get the patient talking so you can determine if there are any warning signs. And to get the patient to open up, you need to gain his or her trust. To establish rapport, show concern, be sincere, and be supportive of the patient's responses. Make sure you have some privacy when speaking to the patient, and if possible, ask visitors to leave so that the patient will speak more openly with you. Also, keep an equal power balance with the patient. Avoid judging, taking sides, or labeling; otherwise, it may seem that your goals and perspectives override the patient's, and this may cause the patient to hold back important information. Also, try standing or sitting so that you're at eye-level with the patient.
Next, use as many open-ended questions as possible to encourage the patient to provide context about his or her overall situation, beginning with questions about the chief complaint. For instance: WHAT happened and what is the patient feeling now, WHY the patient is presenting with this specific chief complaint, HOW did it come about, WHEN did it come about, and WHO else is involved and who is acting as a support system for the patient?
Let's talk about the patient we mentioned earlier. Her chief complaint was abdominal pain at the site of a navel piercing she'd given herself. Here are some questions that might have been good to ask:
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