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What’s in a Name?

Posted By Lisa Zak-Hunter, Friday, September 30, 2011
Whats in a Name? I found myself pondering this question as I walked away from a session in which I introduced my current patient to her new therapist. As an intern, I had a time-limited appointment as a behavioral healthcare provider. My patients knew this, but that did not always make for a smooth transition. Admittedly, I was less concerned about this transfer. To the delight and dismay of her providers, the patient had made remarkable progress and I assumed she would be discontinuing services soon. I was unprepared for how concerned she was to be working with the new therapist. I quickly suggested the three of us meet at our next session, but she remained undecided. During the next session, I ran this idea by her again, but she insisted the decision was mine and that she was ‘fine’ either way. I opted to bring in the new therapist. When it was just the two of us again, her once passive and seemingly nonchalant attitude vanished and she thanked me exuberantly. She had indeed wanted to have a transfer session to help establish trust with this provider. She noted that although she knew and liked him from another clinical setting that individual therapy was different. She pointed out a few times that he had a rather strange last name and that frightened her the most.

I thought about all the variables I had assumed were in place to make this a smooth transition 1) the patient was familiar with the new provider and had expressed liking him; 2) the patient had been making such wonderful progress, I anticipated she would not need the same degree of mental health services as before; 3) the patient would continue at the same clinic with the same healthcare team; 4) the patient would have a familiar and trusted translator, who also served as a community leader. I had not assumed that the new provider’s name would be the biggest sticking point. The new provider and I were both dismayed by this. It reinforced the old adage that one never stops learning.

In the world of medical training institutions, transfers occur every few years once the physician has completed residency. Patients have a variety of reasons for choosing a residency as their primary care site- referred by members of the community; grew up at that clinic; enjoy working with residents whom they believe are more willing to spend time understanding and investigating their condition; feel safer in an institution that may be connected with a university wherein their physician has access to the latest research and technology. For most, this outweighs the downside of cycling through care providers- although there are still a plethora of reactions to this cycle.

As the time approaches, each physician has his/her own way of telling patients about the upcoming transition. There may not be time to address patient’s concerns about a new provider, the patient may not feel comfortable voicing them, or there may be distractions. The patient may leave wondering whether the new physician will address their needs in the same way, will be able to handle their complicated health history, is someone the patient can trust and feel comfortable discussing treatment goals and plans. In the case of my patient, she may have left feeling terrified of her new provider based on his last name. This is likely not a concern she would have voiced with him. If the patient has difficulty establishing trust and confidence in a new provider, it can affect treatment compliance, no-show rates, and the patient’s understanding of his/her conditions. Overall, the patient’s health may be negatively affected and the new physician may wind up feeling frustrated and helpless.

Enter the importance of a team-based approach to healthcare. As we transition into the patient-centered medical home, the impact of provider changeover can be lessened. Other providers are available to discuss these issues, increase communication, provide suggestions for a new provider, and brief the new provider on the patient’s medical and social history, thereby helping establish a provider-patient relationship before the two even meet. Patients’ concerns can be addressed on a more individualized level. Outside this model of care, each physician or institution has more leverage in handling provider turnover, which may not necessarily meet patient needs. Often a general letter is sent to all patients indicating their physician is leaving and the name of the new provider/s who are taking his/her patients. It is impractical to conduct a hand-off to the new provider/s, especially when the physician’s panel includes hundreds if not thousands of patients. A collaborative model allows us to address both these issues: general patient healthcare and individualized healthcare. Patients come from a variety of backgrounds with different medical concerns. In a more traditional medical setting, patients’ individual needs and social contexts may not be consistently addressed.

Now there is a saying that one must not lose the forest for the trees. In non-collaborative healthcare, this may be translated as the need to follow what approach works best for the most patients. I would argue that one must know what types of trees grow in the forest and how to best care for them in order for the forest to flourish. For some patients, the importance of easing provider transitions may be greater than we realize or than patients communicate. This transitioning can be handled in a more responsive manner in a collaborative setting. So, what’s in a name? Quite a bit apparently.

A special thank you to Gregg Schacher for helping ease the transition for many patients!

Lisa Zak-Hunter, MS is a doctoral candidate specializing in marriage and family therapy at the University of Georgia. She completed a behavioral medicine internship through the University of Minnesota’s Department of Family Medicine and Community Health. Her main clinical, teaching, and research interests lie in the realms of collaborative health care and increasing biopsychosocial understanding of mental and medical health conditions. She has a particular interest in adult eating disorders.

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