10.1001stepsforward.2017.0093supp4_1684180875.97065
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Medicine
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Feb 20, 2024
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Teaching Exercise: Having an In-Reach Discussion
Below are 2 examples of in-reach discussions between Diana (medical assistant and panel manager) and
Mrs. Johnson, a patient, at Mrs. Johnson’s annual comprehensive care visit. Read and discuss which version your team prefers and why. Follow the discussion with a role-playing exercise.
Example 1:
Diana
: Mrs. Johnson, my computer tells me you’re due for colorectal cancer screening. After your vital signs I will arrange for you to get that screening done.
Mrs. Johnson
: Okay.
Diana
: You either need to put a stool sample on these 3 cards and bring the cards back to the office, or if you would rather have a colonoscopy, I can arrange it.
Mrs. Johnson
: What is colorectal cancer?
Diana
: Don’t worry about that yet. Let’s just do the fecal occult blood cards. Here they are. Read the directions and bring them back next week.
Mrs. Johnson
: Okay.
Example 2: Diana
: Good morning, Mrs. Johnson, how are you today?
Mrs. Johnson
: I’m okay, thank you.
Diana
: That’s good. I’m happy you are here. Let’s take your vital signs. Now I’m wondering if it would be okay to talk about preventing cancer of your colon. Is that okay?
Mrs. Johnson
: That would be fine.
Diana
: What do you know about colon cancer?
Mrs. Johnson
: I think it’s cancer in my intestine. Do I have it?
Diana
: We don’t think you have it, but we have a test to make sure. And you are right about what colon cancer is.
Mrs. Johnson
: What kind of test is that?
Diana
: There are 2 choices, and I’m going to read information about these choices from this information sheet our doctors have written. [The information sheet describes fecal occult blood testing and colonoscopy; Diana reads from the sheet]
. Which of these tests would you prefer to do?
Mrs. Johnson
: I’d rather take those fecal blood cards home and do that.
Diana
: Great. Here are 3 cards. [Diana reads the details of doing fecal occult blood testing from the information sheet and answers Mrs. Johnson’s questions]
. Do you think you could bring those cards back to me by the end of next week?
Mrs. Johnson
: Yes, I will bring them back next Friday.
Diana
: Excellent. I’ll get the doctor to come and see you now.
Role Playing After reading and discussing these in-reach examples, find a partner and practice having an in-reach discussion about colorectal cancer screening. If you have patient education materials on this topic, practice explaining them to the person playing the role of patient. Switch roles so that both people play the role of panel manager. Discuss the successes and challenges of the conversations as a group.
Source: AMA. Practice transformation series: panel management. 2021.
Copyright 2021 American Medical Association. All rights reserved.
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