DR. EBER: (to users) Considering the warning signs you’ve noticed and the results of the screening tool—if you use one—discuss treatment options with your patient, and collaboratively make a decision about the best course of action. You may want to refer the patient to a mental health professional or prescribe a medication… or recommend a combination of both. Offering a referral for detox and/or rehab may also be appropriate for patients with risky levels of substance use. (to Dr. Rodgers) Have you decided which options you’d like to discuss with Antoine?
DR. RODGERS: Well, he does have pain; which seems to have both physical and psychological components. To address both, I would like him to see an orthopedist and also to speak with a mental health professional. As for treatment I recommend physical therapy and an anti-inflammatory medication, instead of the Percocet. Percocet can be highly addictive and is often an abused pain medication. Additionally, Antoine seems to have been using it to help manage his PTSD symptoms.
DR. EBER: This sounds like a good plan. You’re tackling the underlying mental health issues, in addition to immediately managing his pain; you’re suggesting a safer and long-term solution, rather than a quick fix for his back pain. With this treatment approach it is less likely that Antoine will repeatedly return to seek treatment for the same complaints, or that he’ll become addicted to a prescription pain medication.
DR. RODGERS: I’m just worried that, because Antoine’s so insistent on getting more Percocet, he may not be receptive to other treatment options.
DR. EBER: True—he may not be interested in mental health treatment. But there are techniques you can use to make him more motivated. The key is to make treatment decisions collaboratively. Rather than telling patients they “need therapy,” guide them toward making the decision themselves.
The key is to make treatment decisions collaboratively. Rather than telling patients they “need therapy,” guide them toward making the decision themselves.
Ask patients about their motivation for change—what, if anything, they’d like to change about their current circumstances and how willing they are to make that change.
Outline treatment options, including a mental health referral.
Ask the patient what treatment option they would like to pursue.
If they’re hesitant, discuss their concerns and potential barriers to treatment.
Help them brainstorm solutions to overcome those barriers.
Create an action plan together.
DR. RODGERS: Well, I don’t know what Antoine’s barriers might be, but some of his motivations seem clear: he wants to alleviate his pain and sleep better.
DR. EBER: Right. We can try to guide Antoine to recognize the connection between his pain and insomnia and his emotional stress and to understand how speaking with a mental health professional may lead to a better overall quality of life. If Antoine recognizes this connection, his motivation to see a therapist should increase, and he’ll be more likely to act on the referral.
DR. RODGERS: Okay, I think I’m ready to talk to Antoine again.
DR. EBER: (to user) Now you’ll help Dr. Rodgers continue his conversation with Antoine. Your goal is to collaboratively reach a decision about treatment.
You will hear an example of the talk with Antoine. At times, you’ll hear advice and feedback from your coach, Dr. Eber, commenting on what Dr. Rodgers said and guiding him to more effective techniques.