Last September Doctors of BC’s Council on Health Promotion published a policy paper, Reaching Out: Supporting Youth Mental Health in British Columbia, that encouraged physicians to initiate conversations about mental health with their youth patients and to undertake continuing medical education related to youth mental health. Research indicates that only 25% of Canadian youth will seek support for their mental illness because of a lack of understanding about mental health, a lack of awareness of where to get help, and fear of judgment from friends, family, and professionals. These findings suggest all the more reason for doctors to start routine discussions about their patients’ well-being during medical visits; however, when a patient is unwilling to divulge personal information, physicians may be challenged to start a conversation around a highly stigmatized subject. More often, studies find, it is not what doctors say, but rather how they communicate—the way they enter the room, maintain eye contact, and their general behavior—that affects whether their youth patient will feel comfortable revealing information and accepting treatment.
Developed by the General Practice Services Committee, the Practice Support Program’s Child and Youth Mental Health (CYMH) learning module provides verbal and nonverbal communication guidelines when initiating conversations with youth patients:
• Create a supportive and safe space.
• Demonstrate a compassionate and nonjudgmental attitude, but be real.
• Demonstrate active listening: eye contact, and verbal (“Ah hum,” “Go on”) and nonverbal (head nod) clues to listening engagement.
• Request clarification (“Help me understand,” “Could you explain what you were thinking about that?”).
• Suggest emotional identification (“It seems as if you are feeling frustrated”).
• Do not surmise what is happening for the young person too quickly; you are likely to be wrong.
• If you do not know what they are talking about, ask.
• If you do not know an answer to a question, admit it and tell them how you will find out.
• Establish confidentiality and limits of confidentiality (self-harm, danger to others, etc.) and be very clear about your role as the physician.
• Use open-ended questions (what, when, who, where, how) to learn more about your patient, his or her goals, and potential barriers.
These recommendations reflect similar studies that support physicians’ positive verbal and nonverbal behavior when assessing youth, such as warmer vocal tones, leaning toward the patient, openness, willingness to listen, composure, and some formality, all of which produce higher rates of patient satisfaction.
Through its website (www.pspbc.ca), local regional support teams, and Divisions of Family Practice, the Practice Support Program provides CYMH resources, coaching, and support to help physicians identify a patient’s state of mental health.
Physicians can also refer to www.openmindbc.ca for a list of resources that help youth patients and their families to access information and support services.
1. Doctors of BC. Reaching out: Supporting youth mental health in British Columbia. Vancouver, 2014.
2. Burgoon JK, Pfau M, Parrott R., et al. Relational communication, satisfaction, compliance in communication between physicians and patients. Commun Monogr 1987;54:307-324.
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.
BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:
- Only the first three authors are listed, followed by "et al."
- There is no period after the journal name.
- Page numbers are not abbreviated.
For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org