IHI Open School Video Short

Video Transcript: How Do You Work with Unengaged Patients?

Neil S. Prose MD, Professor of Pediatrics and Dermatology, Duke University Medical Center

Andrew C. Peterson, MD, Professor of Surgery at Duke University Medical Center

Intro text: In this scene, Dr. Andrew C. Peterson demonstrates the wrong way to work with an unengaged patient.

(Dr. Peterson enters, finds man and woman sitting and shakes their hands, and the man is the doctor’s chair)

Dr. Peterson: Mr. and Mrs. Allen, how are you?

Mrs. Allen: Hello.

Dr. Peterson: (to Mrs. Allen, shaking her hand) I’m Dr. Peterson, nice to meet you.

Mrs. Allen: Nice to meet you.

Dr. Peterson: (to Mr. Allen, shaking his hand) Good to meet you, how are you?

Mr. Allen: (not taking eyes off of cell phone) Hi. Good.

Dr. Peterson: Hey, I really need that chair to get into… do you mind if you have a seat over there for me?

(Dr. Peterson gently pushes Mr. Allen off of his chair onto the patient chair.)

Mr. Allen: (annoyed) Sure.

Mrs. Allen: (passive aggressively, to Dr. Peterson) What’s wrong with him sitting in that chair?

Dr. Peterson: Well, oftentimes, you know, it’s the chair that I need to get to the computer so I can review your history, remember all of those forms that you filled out?

Mr. Allen: Yeah.

Mrs. Allen: Okay, it’s just that I don’t see what the difference is, but that’s fine.

Dr. Peterson: (to Mr. Allen) So I looked earlier on, and I saw that you’ve got some erection problems, or impotence?

Mrs. Allen: He’s having some… we’re having some issues together.

Dr. Peterson: Yeah, I got that, but I’m talking to him right now, if that’s okay. (indicating Mr. Allen)

(Mrs. Allen looks insulted, Mr. Allen looks up from his cell phone, looks at Mrs. Allen)

Mr. Allen: Yeah…

Dr. Peterson: You mind if you put the cell phone down?

Mrs. Allen: (to Mr. Allen, annoyed) You should have put the cell phone away. I’ve talked to you about that, and it drives me crazy, so I know that it’s going to drive other people crazy. Just put your cell phone away. (Mr. Allen begrudgingly puts his phone away.) And listen to him. You promised me you would give him your attention. Please? For me? For us?

Mr. Allen: (frustrated) Alright, I’m listening to him!

Dr. Peterson: So… (checks his watch then looks up, to Mr. Allen) …so has anyone tried you on any medicines for your erection problems before?

Mr. Allen: (shaking his head) No. No.

Dr. Peterson: Okay. No pills? No shots?

Mrs. Allen: I’ve been trying to talk about it, this is his first time coming to talk about it. He’s been in denial about it. And he thinks it’s me, he’s trying to accuse me of being the one having the issue…

Dr. Peterson: Well, a lot of people have…

Mrs. Allen: (continues, Dr. Peterson is visibly annoyed with her, checks his watch) …and it’s not me, because I’m just saying, I mean I’m not, like, all over town, but I’m not, like, naïve, and it’s not me, okay? So, I had to drag him in here today.

Dr. Peterson: (to Mr. Allen) So, is this something you’re interested in getting treatment for? Because there are therapies for this that are out there.

Mr. Allen: (still frustrated) I don’t know, you haven’t told me about what these therapies are.

Dr. Peterson: Well, we talked about the pills early on.

Mr. Allen: (more annoyed now) You mentioned pills, but I don’t know if we talked about anything.

Dr. Peterson: (passive aggressively) Okay, yeah, well there are…

Mrs. Allen: (Dr. Peterson looks upset with her again, and he tries to interrupt her several times but she continues.) You might need to, like, debrief him a little better, because he’s a CEO. He’s used to people laying it out there for him in a more organized way, and I think you need to be a little more organized in how you present it to him and then he’ll absorb it. I will make sure that he does. (to Mr. Allen who has his cell phone back out) Are you listening?

Dr. Peterson: Okay, I see people with this problem all the time. So let me just talk to him a little bit. (to Mr. Allen) So there are pills, there are injections, and then there is an operation where we can put an inflatable pump in the penis to help you with erections. (Mr. Allen shakes his head in disapproval, disgusted with the thought, and Mrs. Allen laughs) Are you interested in any of those kind of things?

Mrs. Allen: (still amused, to Mr. Allen) Maybe the pills would be better than the pump.

Mr. Allen: Maybe the pills.

Mrs. Allen: I hope it doesn’t make any noise.

Dr. Peterson: Yeah… (patronizingly, to Mr. Allen) …but you could have gotten the pills earlier, but you never asked anybody about the pills?

Mr. Allen: No, I’ve never had a problem before…

Dr. Peterson: Before?

(Mr. Allen looks at Mrs. Allen)

Mrs. Allen: (to Mr. Allen) That’s not true. Don’t look at me like that! You might not be saying it but, I can tell in your eyes what you were saying and that’s not…

Dr. Peterson: (to Mrs. Allen) You know what I’m doing… Okay…

Mrs. Allen: Can you just tell him this is normal?

Dr. Peterson: (annoyed) Well hold on! I’m sensing a lot of head-butting here and I really think that you two have a lot to work out before we help you with this erection problem, okay?

Mrs. Allen: (incredulous) Excuse me? Did you suggest a psychiatrist? (Dr. Peterson cuts her off)

Dr. Peterson: Well, that might be in the future, so I’m going to let you two work this out, and we’ll make another appointment when you guys are getting along a little bit better…

Mrs. Allen: Are you serious?

Mr. Allen: (sarcastically) Great. That sounds great.

Dr. Peterson: …because this is a family issue!

Mrs. Allen: I don’t think that you approached this the right way.

(Dr. Peterson waves his hand dismissively and gets up to leave.)

Dr. Peterson: Okay. I’m going to step right outside. I’ll have the nurse come in and get your to-go paperwork, okay?

Mrs. Allen: Are you serious? You’re walking out right now?

Dr. Peterson: (not looking at them) Great. Thanks.

(Dr. Peterson leaves)


Intro text: In this scene, Dr. Andrew C. Peterson demonstrates a better way to work with an unengaged patient.


(Dr. Peterson enters, finds man and woman sitting and shakes their hands. The man is in his chair)

Dr. Peterson: Hi Mr. and Mrs. Allen, how are you?

Mrs. Allen: (cheerfully) Hello.

Dr. Peterson: I’m Dr. Peterson.

Mr. Allen: (using his cell phone, looks impatient and is not paying attention) No. We’re not married.

Mrs. Allen: Yet. (laughs)

Dr. Peterson: Oh. I’m sorry, I… my fault.

Dr. Peterson: (to Mr. Allen) Sir, do you mind if I have that chair? I have to sometimes get to that computer while we do our interaction. Is that okay with you?

Mr. Allen: (begrudgingly) Yeah, sure.

(Mr. Allen moves to the patient chair, Dr. Peterson sits down in his chair, he’s now facing Mr. and Mrs. Allen)

Mrs. Allen: (to Mr. Allen) Thank you. That was his chair. (laughs)

Dr. Peterson: Well. It’s very nice to meet both of you. Can you let me know what we can do for you today?

Mrs. Allen: Well, I’ll speak for us. We’ve been having a little problem and it’s been affecting our relationship, so we just had to come in and see what can be done.

Dr. Peterson: So, what kind of problem are we talking about?

Mr. Allen: (still not taking eyes off of cell phone) We filled it out on the form. We talked about it on the form today.

Mrs. Allen: It’s a functional problem.

Dr. Peterson: Well, I read the forms before I came in the room, and it looks like there is some erectile dysfunction. It looks like it’s been going on for several years.

Mrs. Allen: Yes.

Dr. Peterson: And it’s my understanding that at this point you’ve never been under any therapy for dysfunction. Is that correct?

Mr. Allen: Yep. That’s right.

Mrs. Allen: (passive aggressively) I mean, you know, we’ve been trying to figure it out, and he thinks it’s me, and it’s not. I’m not a 22 year old girl any more, 20 year old, whatever…

Mr. Allen: (curtly) That’s the truth.

Mrs. Allen: (ignoring him) …and I know it’s not me. I’m just trying to help him figure it out. For us — for us to figure it out. (to Mr. Allen) For you and for me.

Dr. Peterson: Well, I can sense a little bit that this is really becoming an issue in your relationship, is that correct? And you’re moving forward with the marriage?

Mrs. Allen: Yeah.

Mr. Allen: (ignoring the second question) Yeah, it’s an issue, definitely.

Dr. Peterson: Well, I can tell you, by reviewing all of your medical records and the forms that you filled out for us, I saw that there is some diabetes and some high blood pressure there as well. I can tell you that erectile dysfunction is a problem that happens in millions of men. (Mr. Allen looks up from phone, now interested in the conversation) And often times it is secondary to other medical problems that are going on.

Mrs. Allen: (to Mr. Allen) So you see, you’re not the only one. There are people who have this problem, too, and they’re even younger than you are. So it’s not about your age.

Mr. Allen: Well, I don’t want to take anything that’s going to interfere with my diabetes medication.

Dr. Peterson: Right. Well, the therapies range the options from everything from just a pill that you can take that typically does not interact with a lot of stuff…

Mr. Allen: I’ve seen that on TV, yeah.

Dr. Peterson: …to injection therapy, to even a surgical therapy. And no matter what we need, there will be an end to this where I’m pretty sure we’ll be able to get you some sort of erection that will allow you to have enjoyable intercourse in the future.

Mr. Allen: You’re pretty sure about that?

Dr. Peterson: When we go through these algorithms for treatment, we tend to be very successful with this therapy.

Mrs. Allen: (to Mr. Allen) Well, that’s good. Well, that’s good news.

Dr. Peterson: So, is this something you’d like to discuss a little bit more?

Mr. Allen: Sure.

Dr. Peterson: Okay. What kind of questions do you have right off of the bat about erection medicines?

Mr. Allen: Well, do I have to take it all the time or can we do some sort of one-time fix or something?

Dr. Peterson: If the pills work, often times what you do is you take a simple pill, just about an hour before intercourse, and that’s oftentimes all people need. If the pills don’t work, we can move on to different types of therapies, such as the ones I mentioned before, and then we can work together through this whole process.

Mrs. Allen: Sounds good. (to Mr. Allen) See, it’s pretty easy. It’s good.

Mr. Allen: (indicating Mrs. Allen) Yeah, she’ll be happy, so…

Dr. Peterson: Okay.