In the past few years, prior to just about any medical encounter, I get asked a series of what seem to be non-medical questions, along the lines of:
1-Do you feel the urge to harm yourself?
2-Do you feel abused by anybody in your household?
3-Do you feel safe in your household?
It seems to happen with enough consistency to make me think there is some sort of government mandate to ask these questions.
I’m wondering what would happen if you answered yes to #1. Do they immediately take away your belt and shoelaces and put you on suicide watch?
If you answer yes to #2 or #3 do they immediately inject some well-intentioned but ultimately ineffectual social workers into your life?
I don’t see the value in asking these questions as part of a routine exam or hospital admission. It seems to me that if there is a situation bad enough to engage the authorities it would already be quite obvious and at that point appropriate to ask.
Not necessarily - not all abuse is physical. And for some people, a medical appointment is the only time they can tell someone because the abuser is with them all the time.
Not necessarily. There’s all kinds of abuse - physical, mental, emotional, neglect. Not all of them present themselves easily, especially if someone has gotten really good at hiding them so no one knows they think of as their shame. Sometimes one person, asking just the right question, will get them to admit the kind of abuse they are subjected to. Then not only can the authority be let know, but they can find a safe way to extract people from the situation.
As for self-harm, even today there are a lot of people - particularly young people - that don’t know how to access help for depression and suicidal ideation. And if a doctor - whether pediatrician/PCP, weight loss specialist, or any other - knows that you’re having these thoughts, they can help find the right kind of help.
For my two pennies (or has inflation brought it up to a dime now?), I’m glad that they ask these questions. It puts as much focus on the importance of mental health as it does on physical health. Which we really need more of.
I would think it more likely that this comes from modern, evolving best practices within medicine.
Seems to me I’ve read a little about this, with some doctors taking the position that they’re there to help people stay alive and healthy. Therefore, it might be appropriate to ask about abuse, whether they live in a house with firearms, I think (or maybe I’m making this up) even ‘do they live in a house with a pool’… because all of those things can drastically affect one’s health and cause death. Same for diet, exercise habits and a number of other things.
I can’t say I find this troubling without more context.
I just had a physical and the check in questions were numerous. They asked about Guns, my feelings about personal safety, and bunch of mental health questions about depression, drinking, using drugs, , smoking ,okay fine. Then questions about getting out of the house, talking on the phone to friends and how frequently, going to church and more!
I declined to answer a lot of them. Thanks for asking but not sure what they’d actually do about any of it.
Not that I know of. There are however various guidelines strongly advising these screenings at various ages and for various populations. Some payers have payments to groups based on meeting various quality metrics and compliance with these guidelines is often used. Asking about smoking and offering help with quitting is also a common one.
These questions may not help you but they do help others. Really they do.
I’ve been with my primary at least 25 years and he doesn’t ask me these questions. It’s the gynecologist who always asks - but I’ve only seen her a couple of times and it’s my understanding that for a lot of women, that’s the doctor they see most so it makes sense that she would ask.
Something similar happens in the UK NHS, but for me it’s usually just a pro forma check on alcohol and smoking. Occasionally they will ask about my social/support network, and/or balance and memory concerns, presumably because of my age-group.
No, but they would not ignore it. They would (hopefully) have a discussion with you to determine whether you are at immediate risk to yourself. If there is sufficient risk you may be directed to check in to an ER for further evalution. If you are determined to not be an acute risk you may be given resources to obtain counseling.
These annoying questions (to you) may be a lifeline to someone else who in crisis and may not otherwise seek help.
My sister has, shoot, I don’t remember for sure. Senile purpura, maybe? Which is apparently benign and somewhat common to fair skinned elderly people. Basically it just means the skin and blood vessels are more fragile and easily damaged, so even a small impact can result in a large, dark bruise.
She’s a very active gardener, and is always whacking herself with a branch springing back as she’s pruning something and things of that nature, leaving her with nearly constant bruises on her hands and arms especially. (Or maybe that’s just where they are most easily seen, given she’s a 68 year old woman who doesn’t run around in crop tops or see-through anything.) It’s gotten to the point that as soon as she walks into the exam room at a doctors the first words out of her mouth are “Hi, Dr. X. No, I’m not being abused by anyone.”
It’s my understanding that these questions are mandated by Medicare for those on Medicare, whether due to age or other health reasons. (My late husband went on Medicare at age 50 for kidney failure.)
Anecdote: in 2015 I had breast cancer. I was in a pretty bad place for several reasons of which the cancer diagnosis was the least. I was in the oncologist’s office at least twice a year for a while, and eventually (as I was doing very well) I just saw the nurse practitioner. But I got this questionnaire (12th+ generation dotty/spotty xerox copy) if not every time, then at least once a year. I never came clean about my mental/emotional state but answered everything in an upbeat Pollyanna way. One year I decided to be honest. When the NP came in, I 'fessed up and said, “Usually I kind of fudge on this questionnaire, but this year I was brutally honest about how I’m really doing.” She replied, “Oh, we don’t read those things anyway. They’re just for Medicare.” And I said, “Then I guess I’ll go back to lying.” She didn’t comment but went right on with the checkup without missing a beat.
From a primary care perspective (Peds) my thought is: if only.
The big problem we have in current primary care is the lack of resources to address what is found with these screening tools.
Okay! Initial screening and follow up questionnaire and then discussion identifies significant anxiety and or depression. A well intentioned even marginally effective social worker or other mental health worker is indicated. And none are available. For like ever on a wait list. And depending on plan may be worse than baseline for anyone even being on plan.
So we’ve identified a problem, even a real risk, and now what? Nice to know?
I’m okay with prescribing meds but that, especially as a stand alone intervention, is … not ideal?
FWIW she opens herself up for major risk exposure with that. If there is now a record that a patient shared they were at risk and the provider failed to review or reviewed and failed to act and a patient then goes on to harm themself, or today’s world gotta consider, harms others?
Most do not ignore these screens. Even if we have little to offer.
Having a medical person listen to you is helluva LOT to offer. Sometimes all a person wants/needs is to know that they have been heard.
One time I went to a doctor’s appointment with my late husband. He had multiple medical problems. He asked the doc (a urologist) if he thought it would help if my H sought therapy. The doc said, “Well, you can if you want. But all they do is talk.”
A lot of healing happens when we talk and someone really listens. Along with sticking a needle in the problem, cutting it off, or throwing pills at it.
I agree whole-heartedly with this. CtE is on a bunch of medications to controltheir depression and anxiety. But none of that means anything without someone outside the situation to talk to. We’re lucky, Hubby works at Vanderbilt and we have access to some top notch care. When any of us are dealing with mental challenges, there may be a little wait, but we know that we can be referred to a psych or a therapist without trouble. Having come from a small town, I know that’s definitely not the case everywhere.
Yes! Meds help keep you stable. Talk therapy helps you work through the emotions and traumas that are keeping you stuck. Some people say they just talk to friends or family members, and that’s good because they can offer insight into the problem. But they’re too close in most circumstances and having an objective outside person to talk to helps too.
I’m 64, not on Medicare but will soon be. I have a bunch of medical issues and therefore see multiple providers on a nearly weekly basis. Mostly I’m annoyed by having to answer these and other questions over and over again. I can usually avoid most of the annoyance by using E-Check-In.
This line of well-being type of questioning became prevalent around the same time Covid hit, or at least that’s when it became noticeable to me. That’s why I was postulating it was some sort of gov’t mandated thing.
Those look like medical questions to me. They concern you health. Non-medical questions would be questions like “What is you favorite color?”, “Do you like my new hairstyle?”, or “Do you like gladiator movies?”.
