How They Do It: Physicians Describe Building a Physician-Patient Relationship with People Who Use Illicit Drugs

Primary care clinicians receive little guidance on building a doctor-patient relationship with people who actively use illicit substances. To describe the approach experienced family physicians (FPs) use with female patients who are illicit drug users, investigators performed qualitative analyses of in-depth interviews with 10 FPs. Purposeful sampling ensured variation among participants. Sampling ceased once no new emergent themes were identified during interviews.

• A 2-phase doctor-patient relationship was identified:

• Engagement Phase—The physician established the relationship over multiple interactions. A “testing period” typically occurred, during which trust was established. Other features included creating a calm presence to deflect patients’ chaos, communicating acceptance to patients, and demonstrating to patients that they would not be abandoned.
• Maintenance Phase—Physicians reported the importance of continuity of care and “meeting people where they’re at.” Continuity was characterized as “intense and frequent visits over short periods of time, followed by extended absences.” ”Meeting people where they’re at” was described as not pushing patients too hard and allowing them to set their own priorities.

Comments:

This study suggests strategies for the novice health-care provider to engage and maintain active illicit drug users in care. The depiction of continuity as periods of intensity followed by absences is a helpful reminder to welcome patients back to care when they’re ready. Whether these longitudinal patient-physician relationships improve health outcomes for patients with active illicit substance use ought to be studied.

Hillary Kunins, MD, MPH, MS

Reference:

Woolhouse S, Brown JB, Thind A. ‘Meeting people where they’re at’: experiences of family physicians engaging women who use illicit drugs. Ann Fam Med. 2011;9(3):244–249.