Preventive medicine: giving patients the hard sell.

Have you ever found yourself busily attending to a patient’s acute problem when all of a sudden a nagging voice inside your head reminds you that you haven’t yet asked the patient about that needed flu shot, Pap smear, tetanus shot or other preventive service? Although health plans and government agencies are often quick to remind us of our preventive failures, many physicians shy away from prevention, viewing it as a can of worms they simply don’t have time to open. The uncertainties of preventive care coding and reimbursement can also complicate matters. (See “Getting paid for prevention,” page 23.) One tactic that can help in these situations is to enter the exam room or hospital room with at least one preventive goal in mind and be prepared to “sell” it, using a few well-applied strategies: 1. Prepare a one-liner. Have a short speech prepared in your mind so you can advocate for the needed intervention. Consider this clinical scenario: You are in your clinic in early October, and thanks to your good planning, you actually have a decent supply of influenza vaccine. Your nurse is collecting a patient’s vital signs and briefly asks about the flu vaccine. The patient, who has diabetes and chronic heart failure, hasn’t had a flu shot but declines the service, and the nurse notes that under the chief complaint. As you enter the exam room, you say hello to the patient and exchange pleasantries, and then – before you launch into the chief complaint – you say: “My nurse noted you do not want the flu vaccine this year. I strongly recommend this shot, especially for a person like you. Your sugar levels