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recent ultrasound. Surely a trained physician knows more about pregnancy than a
genetic counselor.) This form of resistance provides relief from a seemingly
unbearable situation by dismissing information and expertise and providing a ratio-
nale for disengaging.
9.1.5 Responding to Patient Resistance
There are several strategies you might use to address patient resistance:
Strategy: Explore the reasons for their resistance. Keep in mind that patients have
no obligation to attend genetic counseling, and part of your job is to determine
whether they want counseling.
Examples:
- If a patient seems rushed or in a hurry, acknowledge this: the patient may truly
have somewhere else she/he needs to be and will appreciate that you took the
time to notice and understand this need. Clarifying that a patient is indeed in a
hurry will also alert you to be as efficient as possible in your use of session time. - Patients may be resistant or afraid because they’re worried about having to pay
out-of-pocket for yet another service. Find out if financial coverage is a
concern. - A patient was referred for genetic counseling to discuss her risk for having a
baby with tuberous sclerosis (TS). The patient was diagnosed with TS 3 years
ago during her first pregnancy, when fetal cardiac tumors were identified by
ultrasound. The baby and mother were examined upon delivery, and both were
given a diagnosis of TS. The patient never returned to the medical geneticist, and
a cardiologist had followed only her son. When the counselor was assessing the
patient’s understanding of why she was referred, the patient said she had no idea.
The counselor explored this further with her, and the patient admitted that the
cardiologist wanted her to come in to discuss TS and her risk for having another
affected child. Further exploration revealed that she did not believe she had TS,
rather her findings of TS were familial birthmarks. Because she was in denial
about her diagnosis, the genetic counselor focused on her feelings about her
diagnosis, why she did not believe it, etc. The patient was able to engage in a
dialogue about these issues, feelings of guilt that she passed this on to her son,
her fear of passing the condition on to other children, etc. - A patient came in and sat down with a huff and crossed her arms. The counselor
said, “You seem uncomfortable. Is there something I can do?” The counselor
hoped this response would allow the patient to vent her anger, and the counselor
could determine the reasons for her feelings. - The genetic counselor’s role is to briefly consult with the patients in the cranio-
facial clinic to determine the need for a complete evaluation in pediatric genetics.
Some of the patients have multisystem involvement (not just craniofacial abnor-
malities) and consequently have been seen by multiple specialists. When the
9 Patient Factors: Resistance, Coping, Affect, andfiStyles