Talking with Patients

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.

Imagine Lori, 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.

When talking to someone like Lori your 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, it’s important to use communication techniques that motivate patients, like Lori, by showing them respect, eliciting their experiences and approaching them with empathy.

To share information respectfully, try first asking for permission or asking what the patient already knows. Many patients are quite knowledgeable about their own conditions. Then, you can correct any misconceptions and share anything new, then follow up with a question to hear their reaction. This is called Ask-Tell-Ask.

When taking the patient’s history, Open-Ended Questions, which don't have a yes/no or one-word answer, can elicit more details and help you better understand her situation.

Patients with opioid use disorder face a lot of stigma and judgment. It's important to show empathy for Lori's situation.

Affirming the ways in which she is capable and successful helps her recognize she is strong enough to seek recovery.

Validating that Lori's struggles are the result of a medical illness can help her feel less guilt and shame.

Normalizing that others have gone through the same thing and found recovery will help Lori feel capable of change.

Below are examples of a poor conversation and an ideal conversation with Lori.