Journal 07-06-2011
Taking baby steps.
Now that I am familiar with information about testing options as patient education, the next step would be training counseling, which is not easy for sure, but is essential for being a qualified GC.
I used to think counseling is only for psychosocial issues when patients present anxiety, stress, depression etc. I didn’t think personalized GC session is actually part of it, or the very beginning, of counseling. A GC should sense what and how much information the patient wants, especially for those who had GC before.
Our first patient today just turned 35. She apparently was anxious about her age related risks. After little contraction, I asked what her special concerns and questions were for today. She started to address the age. “I am still very young, I feel no difference now and two years ago when I had my son. But my doctor asked me to see you”. I took it as normal patient or reaction so I took her family history first before I addressed any of her concerns regarding age of 35. After the session, XXX commented that this patient represented the typical women who just turn 35. They don’t understand the risk gradually increases rather than increase all of a sudden. Once their doctors ask them to see us, usually it will lead to anxiety and nervousness. They are different from those who are at their 40s when usually pregnant women realize their risks of having a baby with chromosome abnormalities. So lessen their anxiety by educating them at very beginning is helpful to establish rapport and come up with an effective GC.
Luckily, I practiced in the afternoon. When I prepared the case, I noticed that the patient, a 40yo woman with G2P1, was interested in having a CVS in first trimester. I asked myself “why is she interested in a CVS? Is it because her first kid has chromosomal abnormalities? ” With these questions in mind, I decided to address her concerns about CVS first. When I learned that she had a GC when she was pregnant with her son, who is a healthy baby, I thought she must have known testing options. So I asked why she was interested in CVS, any special concerns? She said actually her doctor sort of pushed her because her age. So I started talking about CVS and amnio, the benefits, limits, procedure and procedure related risks of miscarriage. Also I asked if having CVS would change their management about their pregnancy. Then I introduced the age related risk to further educate them why their doctor thought they might want to have CVS. I sensed they relived after learning all information. Since people perceive number differently, so they didn’t think having CVS was necessary. They decided to start with sequential screening after we discussed it. At last, I took family history.
I am kind of happy with my performance after this session, though it is not perfect because I felt later that I might have given them redundant information given the fact that they had GC and SS before. But I am happy that I personalized the session and addressed the immediate concerns. And I was taking a baby step in terms of training counseling skills.
