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In this MD Newsline exclusive interview with obstetrician and gynecologist Dr. Wendy Goodall McDonald, we discuss how to approach challenging patient-physician conversations and gain a patient’s trust. In particular, we discuss this topic as it relates to broaching conversations about heavy menstrual bleeding, race, and current events.

MD Newsline:

How do you make your patients with heavy menstrual bleeding feel comfortable discussing the issue with you?

Dr. Wendy McDonald:

“My strategy to help all of my patients feel comfortable is to ask them the question, ‘what’s going on with you today, and how would you like me to help you?’ Because you don’t want to assume that a person because they’re telling you about symptoms that sound severe to you, that they are ready for an extensive treatment option. They may want to just discuss the symptoms first. They may want to understand if these symptoms are unsafe for them. Perspective is everything.

If you grew up and your mom had heavy periods and pain every month and laid in the bed two or three days out of the month, every month, you would think that’s normal. But it’s important to find out from that person what they’re experiencing and start the conversation as to what’s healthy, and what’s safe, and what they may or may not have to go through.

I will present to my patient the option, ‘do you want to go through this every month? Do you want to see improvement in these symptoms? How would you like for me to help you.’ And if they say, ‘well, what do you think?’ Well, now I’ve already opened the door for them to receive some options that I will present to them.

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So, I think the first thing [to do] to make a person feel comfortable is to not impose our treatments on what they’re telling us but to ask them what they would like to see happen, what they would like to see change. And maybe it’ll be something as simple as, ‘I don’t want to be stuck in bed every month,’ or, ‘I want to stop soiling my sheets.’ Well, let me give you some options that will help you to not soil your sheets every month.

Letting the patient lead the discussion, letting them lead their management path, I think is really important to build trust.”

 

MD Newsline:

Should a provider discuss race and current events with their patients?

Dr. Wendy McDonald:

“Let’s talk about the ‘dos’ and ‘don’ts’ when it comes to discussing race relations with your patients. We’re all human, right? So even as healthcare providers, we are experiencing what’s going on in the world, and the different racial clashes, just like our patients are. But we may be experiencing them in different ways, especially if we’re from a different ethnic background than our patients.

If a person wants to discuss how they feel, they will. And if they don’t want to discuss how they feel, particularly in the setting of their doctor’s visit, they may not. So that is the first opening, I think, is to find out how that person is doing, without probing to see how they’re doing, specifically when it comes to race relations in the United States.

If the person seems to be experiencing more stress, or they’re still telling you things that seem to be related to their physical impact of stress or depression, I think it is appropriate to ask that person, ‘why do you feel like you’re having more stress at these times?’ Or, ‘why do you feel like you’re more depressed in these times? Is there anything that I can do to help?’

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Because that person still may not want to tell you exactly what’s going on with them, but they may be open to finding out if there is something more that can be done. Meaning potentially seeing a therapist, potentially seeing a psychiatrist, potentially even discussing their health when it comes to some of the other side effects of stress or sleep deprivation that they may be experiencing.

What I would not do, the ‘don’ts’ when it comes to being a healthcare provider dealing with patients of ethnic backgrounds in the setting of current events in this country and race relations and clashes, is I would not ask them to help you to understand their plight or their feelings better.

This is not about you right now. So, I think the biggest ‘don’t’ is to not use your patient, who is of an ethnic background, for your own understanding or to try to understand the other side of what may be going on in the Black Lives Matter [movement].

I think finding out how they’re doing and if there’s anything that you can do to help is the most important thing that you can do for that person. And if and when they’re willing to let you help, then do your best to do so.”

 

Responses have been condensed and lightly edited.

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