Dialogue Volume 15 Issue 1 2019 - Page 30

PRACTICE PARTNER A disease, not a character flaw To combat stigma, doctors should focus on communi- cation and education. To start, that means respecting the person behind the illness. They have a disease, not a character flaw. Be aware of how words and actions can lead to harm instead of healing. Patients dealing with mental health or substance chal- lenges may already have a poor self-image. Doctors (and other care providers) should recognize their power to belittle or diminish by a comment, a gesture or a look. Use language that conveys concern instead of judg- ment, and acknowledges that recovery is possible. Even the choice of language used privately can be damaging. A study reported in the Journal of General Internal Medicine in May 2018 found that bias can be transmitted from one clinician to another through medical records. The study used a hypothetical patient and medically identical information. One record used neutral language to describe the patient, e.g. “He has 8-10 pain crises a year, for which he typically requires opioid pain medica- tion in the ED.” The other record used language that implied a value judgment, e.g. “He’s narcotic depen- dent and in our ED frequently.” Doctors who saw the stigmatizing language in records tended to have more negative attitudes towards the patient, and less aggres- sive treatment plans. Words matter. So do assumptions. Remember who’s vulnerable – anybody, of any age, from any background. As Dr. Courbasson reminds, the substance user can be the young street person. Or the respectable grandma hooked on anxiety meds (and who sometimes mixes it with other meds). Don’t stigmatize by stereotyping. When talking to patients, the way the health issue is framed is important. There may be psychosocial com- ponents, but these are medical/biological/physiological problems. Using that conception can also help doctors see these illnesses (as one study noted) as more control- lable, less permanent and more recoverable. As with any area where care can be improved, training is essential. That can mean learning more about sub- stance abuse and mental health disorders, and specifi- cally about stigmatization. Many resources are readily available (see sidebar below). We break stigma when people see mental health or substance abuse challenges as a disease. When we avoid prejudice and labels. And when patients feel comfort- able about coming forward for help. When they do, the hope is that they encounter profes- sionals who are equally compassionate and caring to all patients – whatever their health-care issue. No shame, no blame. MD Resources In 2018, the Mental Health Commission of Canada and CAMH To help with younger patients, use a related CEP resource: “Youth launched an “Understanding Stigma” online course. Hosted at Mental Health: Anxiety and Depression Tool.” It looks at support- camh.ca, it helps health care providers and front-line clinicians ing your patient, screening and assessment, management, and develop strategies to improve attitudes and behaviours. The follow-up and monitoring. goals: improve patient-provider interactions, and enhance care for people with mental health/addiction problems. CEP also has an “Opioid Use Disorder Tool.” It walks primary care providers through screening, diagnosing, treating and commu- The Centre for Effective Practice offers useful resources at nicating with patients who have (or are at risk of) OUD. The tool cep.health/tools/, including the “Keeping Your Patients Safe” emphasizes a stigma-free and empathetic approach, acknowledg- guide. Primary care providers can face uncertainty around identi- ing OUD as requiring chronic disease management. fying and acting on signs, symptoms or behaviours that suggest 30 a mental health condition in adults. This CEP guide looks at how The Mood Disorders Society of Canada has an interactive online to investigate and assess, and initiate appropriate referrals and course called “Combating Stigma for Physicians and Other interventions. Health Professionals.” See mdsc.ca/continuing-education/. DIALOGUE ISSUE 1, 2019