Asking patients difficult questions: “Are you unemployed?”

The Mind the Gap blog has an article titled “What Do Doctors Know About The People In Their Waiting Room? – The Scourge of Unemployment” that got me thinking:

Given today’s tough economic environment, chances are that 15% to 20% of the people sitting in most doctors’ waiting rooms are out of work. Do you know who they are? You should. Losing a job is a highly stressful event. For most employed adults, work is a central part of one’s life and identity and a major source of income. While job loss affects people differently, research suggests that loss of a job affects how many people feel – emotionally and physically. Job loss, as well as job insecurity, has been linked to increased mental distress (depression) and physiologic responses such as a weakening of the immune system, increase inflammatory response which is associated with cardiovascular disease as well as an increase in blood pressure. Depression is also correlated with more physician visits, medical tests, RX medications, hospitalizations and decreased adherence among patients

Whilst I fully agree with this, I find the proposed solution conflicts with my understanding of how conventional GP consults work:

For a starter “Ask your patients what’s going on in their life, including current or potential job loss and problems at home” is easier said than done when you’re a busy Doctor with limited time, a waiting room of patients and reception staff and cleaners waiting to lock up/go home.

Trying to get to the point with a “Are you currently unemployed?” question could also illicit offence from some adults and as the author writes “unemployment and ..under employment.. are not subjects that a lot of people are comfortable bringing up in polite conversation…even with their doctor” so what makes us so confident that it will even lead to a honest answer from a patient who’s come in about an ear infection?

I do agree with the sentiment though:

Understanding the context of the patient’s life will allow you to provide true patient centered care to patients that desperately need and want your help

But I can only see one way of effectively doing this and it involves enabling patients to give their history to the Doctor prior to the consultation using an interactive medical history questionnaire. More clinics should be removing the unhygenic thumbed magazines and installing touchscreen desktop mounted tablets to utilise patient time in the waiting room. It’s not as though this type of technology is exactly sci-fi – UK Job Centres have already installed over 9,000 touch screen panels:

Better still let patients complete the interactive questionnaire before arriving by visiting your clinics secure website and make it an integral part of the online appointment booking system.

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