Psychosocial concerns

Possible stations – with a patient

  • Concerned about a test
    • Try to find the underlying reasons for their concern
  • Wants a sick note because of problems at work
  • Wants to self-discharge because they need to care for a partner at home
  • Wants to die
  • Wants to lose weight because a relative died recently of obesity-related health problems
  • Wants to make a complaint
    • Don’t forget to mention the patient advice and liaison service (PALS)
    • You can say you are sorry they feel that way/went through that but generally don’t apologise/admit guilt
  • Feels another doctor examined them inappropriately/didn’t offer chaperone

Possible stations – with a patient’s relative

  • Carer struggling
    • Social services can do a care assessment to provide money/respite/help
    • Charities (e.g. carersuk.org and carerssupport.org.uk) offer help and support groups
    • Health visitor for children
    • Stress they’re not alone
  • Concerned about social care arrangements for elderly relative
    • Social services can arrange care
    • There are also private care organisations
    • In a crisis, doctors can refer to the rapid response team for short-term care
  • Carer says patient has stopped taking their medication and wants to know how to make them take it
  • Is concerned their relative may have cancer because they know someone else who had similar symptoms and then died of cancer

Possible stations – with a colleague

  • Another member of the team is not pulling their weight, is always late, makes mistakes, or smells of alcohol etc.
    • Options include speaking to the culprit directly (usually best initially), and then considering speaking to their senior (offer to be present) 
    • If patients are/may be at risk, you must take action and inform a senior. You should tell the culprit you are doing so.
  • Being bullied by another member of the team
    • Could they approach the perpetrator? Can they speak to their supervisor/senior/human resources? Offer to be present if possible.
    • If they have tried to resolve it but had no success, they may need to make a formal complaint
    • Screen for depression (but remember you are not their doctor and should direct them to their GP if needed)
  • Issues at home affecting work
  • A colleague who is stressed
  • Shaken up by something that has happened (e.g. a patient died)
    • They will need ongoing support – can they speak to their supervisor or occupational health? Offer to be present if possible
  • A colleague has made a mistake
    • Have a non-judgemental attitude
    • Emphasise the ‘no blame’ culture when mistakes are admitted
    • Incident reporting can help everyone learn so the same mistake doesn’t happen to others
    • Honesty is the best policy 
  • A health visitor concerned about a child abuse within a family without any evidence because he/she missed a similar problem previously

Aims of the station

  • Be non-judgemental
  • Empathise
  • Listen!
  • Pick up on cues and show you have heard them
  • Address their ideas, concerns and expectations (ICE)
  • Suggest possible solutions

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