Monday, February 20, 2012


In Medicine, we are taught to assess risk. To identify factors that make a condition more or less likely. It is akin to a detective novel. Uncovering and eliciting information to put together a high, medium or low risk for conditions. It enables us to generate our differential diagnosis - the list of most to lesser likely items associated with a symptom.

Risk assessment is not an emotional charged process for the assessor.

Pulling out the Framingham risk factors for heart disease and assessing becomes a memorized habit. Switch seats and it becomes an entirely different experience.

Patients often say that they'd rather not visit their clinicians office because we will 'find something' (wrong) with them.
In fact, in lifestyle and disease prevention, in history and laboratory screening - we do just that. But it is important for the assessment to not stop there. We have a role in assessing what is right as much as what is not. The twice weekly exercise (in contrast to none) needs to be identified and lauded, for example. Dr Bloom's Trauma model talks about SELF - safety, emotions, loss and future. Without future, there is no healing from trauma. As we 'do our jobs' and identify health risks, patients can feel traumatized. So we need to intentionally include optimism in the process.

During a Ujima Lay Health Ambassador training session, the participants brought this point home to me. We talked about risks associated with heart disease. As I went through the components (DM, HTN, premature heart disease, elevated lipid levels, smoking, etc.), the vibe from the group back to me was of being sad or overwhelmed. This made me mentally pause and reconsider how I was presenting the information. I paused in the laundry listing of 'bad stuff' to then start to highlight the impact of intervening in each factor. Inside of the runaway railroad train of bad stuff down to Heart Attack land, I covered one area at time and then talked about how, for example, quitting smoking, can decrease your risk.

Every time you have the privilege to teach, you can also have the opportunity to learn - another way of thinking, a question not yet considered, the impact of your information.  The group enabled me to truly appreciate how the automatic nature and the speed of risk assessment can adversely affect hope for the future. And if hope for the future is annihilated, the likelihood of intentional action for behavior change is too.
So my take home with this is that despite time constraints to quickly deduce and figure out risks, it is even more important in imparting hope for positive change when relaying this information to a patient. From risks to findings it important to put the data in a context that promotes understanding and change. For example - What lab value is abnormal? What does it / can it mean? What can I do about it?

Perhaps risk and hope are a yin/yang type of thing - highlight the change I need and support me to be optimistically ready to take action (and coach me to make the hard changes.) Either way, we need to have one script inside our heads and a different language of delivery to patients if we hope to have them a) come back and see us again :> and,  b) take action to promote healthier lives.

1 comment:

  1. If wish for the near future is annihilated, the chance of deliberate action for actions change is too.
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