Patient not willing to discuss further

This question is looking at your response to a difficult patient. You will learn more about the different types of 'difficult patients' and the reasons why people act this way, however at this stage you are expected to know how to at least attempt to make the patient feel comfortable and safe enough to talk with you, and trust you enough to share personal details.

Here are some key elements to include in your answer

These points are based on a scenario where a patient is unwilling to discuss a sensitive issue like a possible STI.

• Patient autonomy and respect
  • acknowledge the patient's right to make decisions about their healthcare
  • Express a commitment to supporting the patient in a way that respects their wishes
• Confidentiality assurance
  • Address patient's concerns about confidentiality proactively by explaining the ethical and legal boundaries of confidentiality in a reassuring way
  • For instance, emphasise that their information will not be shared without consent unless required by law
• Communication skills
  • Use open-ended questions to invite discussion without pressure
  • Reflect empathy and understanding through tone and body language
• Patient education
  • Explain the importance of addressing STI symptoms early to prevent complications and protect partners.
  • Inform them about the availability of discreet and confidential testing and treatment options.
  • Tailor information to their level of health literacy.
• Cultural competence
  • Acknowledge and respect the patient's cultural background or beliefs that may influence their comfort in discussing the issue.
  • Be mindful not to make assumptions about the patient's values or stigmatise their concerns.

Some common pitfalls to AVOID

• Minimising the patient's concerns - don't dismiss their worries about confidentiality as this may come across as invalidating
• Technical medical jargon - over-using clinical language can increase the patient's discomfort and further hinder communication
• Rushing to investigations and solutions - immediately suggesting tests and treatments without first addressing the patient's emotional and psychological barriers is inconsiderate and unsympathetic
  • It will potentially stress the patient out more, and make them less trusting of you
• Assuming the patient's motives behind not wanting to talk - you never know what is going on inside someone's head, or what prior experiences they have had
  • Focus on creating a safe space for them to share if they choose to

Suggested Structure for This Question

• Introduction - brief summary
  • "In this scenario, the patient is hesitant to discuss symptoms suggestive of an STI due to concerns about confidentiality and judgement. My approach would prioritise respecting the patient's autonomy, addressing their concerns, and fostering trust."
• Acknowledge the patient's concerns
  • "I would start by reassuring the patient that their concerns are valid and understandable. I'd acknowledge their apprehension and express my commitment to providing non-judgmental, confidential care."
• Build the patient's trust
  • "To build trust, I would explain the legal and ethical guidelines around confidentiality, emphasising that their information will remain private except in specific cases where disclosure is required by law."
• Foster open communication between yourself and the patient
  • "I would use open-ended questions and a calm, empathetic tone to create a space where the patient feels comfortable discussing their concerns if they wish."
• Educate and empower the patient
  • "If the patient feels comfortable continuing, I would provide clear, non-judgmental information about STI testing and treatment, highlighting the importance of early intervention."
• Respect the patient's decisions ultimately
  • "If the patient remains unwilling to discuss further, I would respect their decision while leaving the door open for future conversations."
• Conclusion - summary of conversation
  • "Ultimately, my goal would be to support the patient in a way that aligns with their values and choices while ensuring they have the information and reassurance needed to feel safe seeking care."