How to approach this type of work
August 1, 2021 4:19 AM   Subscribe

I am currently working as an admin assistant for the NHS in the UK. I have been asked if I would like to undertake the role of contacting patients with Hepatitis C and persuading them to attend a clinic appointment.

Many of the patients fail to attend their appointments and the uptake is low. I also believe that because of their situation, many have gone off the radar. I have no experience with this type of work and am looking for any tips/advice on how to approach this or examples of scripts I could use. Thanks in advance for any suggestions.
posted by charlen to Work & Money (4 answers total)
Best answer: I've worked with this population and this seems to be more of a social worker thing than simply have people call and say "hey! You have missed your appointment. Can you come this day?" If you aren't a social worker and have no experience in this I would ask what kind of training are they providing you before agreeing.

If it is simple appointment reminders and that's what you want to do, go for it. Otherwise I would be wary of being undertrained and ill equipped to actually respond in a way that will be useful even with a variety of scripts provided to you. People don't follow scripts. They just don't.

This sort of thing is a huge pet peeve of mine for many reasons which undervalues the training and experience of actual social workers and assumes that phone calls are a thing that anyone can do because it's just a phone call.

What resources will you have to help people actually make their appointments? That will change your scripts significantly. If you can say screen for needs transportation assistance and then provide ways for them to get to appointments then that's one thing . But if you ask "do you have difficulties getting to appointments, if so what are they? " and someone responds "I can't afford to travel by bus" and you have nothing... The conversation is now over and while you know why you aren't able to fix that. So the conversion ends and all you know if that this person won't make their appointment.

Here (US different medical systems all that stuff) there are programs that have screeners who ask a set of questions about things like this and escalate to a higher level professional if warranted.

So if you screened (like 10 standardized questions) for someone with problems seeking care and they answer in a way that says 'homeless, have a substance use disorder and low income' you could send them to someone who could respond in a way that may or may not be helpful, but is at least prepared to aknoweldge these issues. It really depends on how the program is set up.

The screeners have a script that's pretty clear and there isn't any freeform talking. It's also carefully worded to help get accurate information out of people, and questions that seem to not be misinterpreted. You ask the questions, report that based on these answers they qualify for additional assistance and refer to the additional assistance, or don't if they don't qualify.

I'm sorry this isn't super helpful in terms of what to do if you take this job. Honestly, I personally don't see much value in the phone reminders tele programs anyway. It is useful for some populations but it's really not generalizabile to all groups. It doesn't build trust or really give time for people to build a relationship to reflect or even disclose their actual barriers to care. That takes time and effort that just cannot be done in these types of programs . The population I work with doesn't even have consistent access to cellphones or places to charge them, so in general a program like this will never ever reach them.

I'd expect much of your time being making phone calls and just even trying to get someone to answer.
posted by AlexiaSky at 5:36 AM on August 1, 2021 [9 favorites]

Best answer: I have extensive experience with this type of work. Fundamental to any other part of my response is that this is a role which will demand tremendous empathy of you, not simply as a service to your patients, but as a mechanism by which you can permit your own failures -- many of the patients you speak to may not buy your pitch and you may feel as though you are failing them or failing the NHS if you can't use empathy to recognise that the patients are acting from complicated emotional and pragmatic circumstances are far more likely to act according to their complicated perspectives than they are to act according to your requests or encouragement. Do good work, but don't blame yourself u duly for poor results.

Your scripts should emphasise the ways in which attending appointments will help the NHS accomplish things on behalf of the community and nation as well as the patient as an individual, because people are susceptible to that kind of emotional manipulation, statistically speaking.

Your scripts should minimise presumptuous language about why patients may not want to attend -- a bit of presuming may help a patient feel understood and recognised, but too much will make them feel the opposite, as though they are being generalised and objectified.

Your scripts should emphasise the ways in which a patient's privacy and autonomy will be preserved, as no one wants to feel like they will be limited or exposed by the consequences of their health or treatment.

Those are my initial thoughts, I'm happy to chat more over DM if you think that would be useful!
posted by chudmonkey at 5:38 AM on August 1, 2021 [7 favorites]

Best answer: I have no experience with this type of work and am looking for any tips/advice on how to approach this or examples of scripts I could use.

I'm currently reading the book Never Split the Difference which is a series of lessons in negotiating written by a FBI Crisis Negotiator. Most negotiation books are based on abstract ideas of rational actors and hands-on learning is classroom exercises designed to teach MBAs out to out negotiate one another. But your problem, like many, is closer to a situation where the counter-party is irrational and the behavior is at some level self-destructive.

Overall I suspect you'll find many worthwhile lessons in the book, and I'm thinking of one chapter in particular that describes how script design is at odds with human psychology, and how flipping the script can work better than the typical 'getting to yes' script (and sadly, how rarely Powers That Be will accept it). The book describes many tools for active listening, like mirroring and labelling, that help establish trust and empathy. Obviously reading a book isn't gonna be sufficient for a job so IMO ask what training is made available.

That said, I'd be surprised if you were writing your own scripts; the NHS should already have a team designing and improving outreach scripts, so that might be taken care of already. If I were you, I'd ask why the person proposing this thinks you'd be a good fit for the job, and see if they're recommending it because it's right for you, or if they have an ulterior motive like foisting off a task with high burnout / turnover.
posted by pwnguin at 10:30 PM on August 1, 2021

Best answer: I'm a long-time hepatitis nurse, very immersed in attempting to get people with exposure to hep C into clinic. It's a very, very difficult task if your particular population is largely involved with drugs or in medication assisted treatment, such as methadone. These people lead very complicated lives, what with methadone clinic mandates on their time and activities (pee in a cup at a certain time before dosing, get dosed, attend mandatory group and individual therapy sessions - there's a lot. It can be almost like a full time job where the client has little say. Caveat: this is the US, not the NHS. Things might be quite different there.) Active drug users have even more complicated lives, but treating active users with hep C is a brilliant calling, since it reduces the pool of people with hep C and also reduces the number of potential newly infected people if the non-infected drug user ever shares injection equipment with someone infected. Not sure if the NHS allows treating active users.

All this to say that "clinic hours" may be impossible for such a person. In the hospital where I worked clinic was held 2 mornings a week, no evenings or weekends. Well, the methadone clinics required all morning appointments and were totally inflexible. They always, always come first because people absolutely need their doses and often have to work around jobs, childcare, etc. So finding a convenient time for these people to come in was almost impossible. We even got a grant to put a social work student Full Time in one busy methadone clinic, and while she was able to make appointments for some of the less burdened clients, very few showed up.

One suggestion to you is to learn about the different hep C tests and what they mean. In the US every methadone patient is screened with a hep C antibody test but it was up to the patient to go back to their own personal doctor to request a virus test. Plenty of people who have a positive hepatitis C antibody test don't have hep C; they have either cleared it spontaneously (maybe 30% of people) or they have been previously cured. A positive antibody will be positive forever, while the virus test (PCR usually) will tell you if there is infection. There is NO SUCH THING as "dormant" hep C. It's either active or not there. (This is different from Hep B which is a much more complicated virus) So it will help you immensely to know whether the people you call are hep C antibody positive only or if they have been further tested and are hep C PCR positive.

You know what made the biggest difference? The new treatments. They are all oral medications, treatment takes typically only 8 to 12 weeks, and they CURE hepatitis C. Often there is no bloodwork required at all during or even after treatment - they are that effective. And for most people there are no side effects. For that kind of miracle cure people were much more willing to try to arrange childcare or job accommodation.

So if I had your task I would lead with the practically painless treatment, its short duration, its all-but-guaranteed cure and the low burden of doctor appointments needed. I found that patients were overwhelmingly very worried about hepatitis C but sort of paralyzed about moving forward when there was a large burden of appointments and the pretty poor success rate of the previous generation of treatment. The new oral treatments have been a total game changer.
posted by citygirl at 11:33 AM on August 2, 2021

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