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genetic counselor recommends yet another evaluation (medical genetics), she is
often met by some amount of resistance. In most cases, it relates to a lack of
understanding and/or a view that the counselor’s goal of evaluation is different
from that of the family’s (e.g., the family mistakenly believes it is to provide a
label rather than to ensure quality care). This can be addressed by discussing the
goal of the medical genetics evaluation.
Strategy: View some degree of resistance as natural and normative (usual).
Examples:
- A genetic counseling patient appeared to be hostile right at the start of the ses-
sion. She was unhappy with the appointment time, felt that staff should be avail-
able in the evening as the hospital is open 24 h, and thought the directions to the
clinic were confusing and she had to pay for parking. She was also (understand-
ably) unhappy that there was an hour’s delay before she was seen. The patient
proceeded to instruct the genetic counselor to “fix these problems.” The genetic
counselor tried to empathize with the patient’s frustration about appointment
time, etc. “It sounds like getting to clinic has been a very frustrating experience
for you, and I apologize that we are behind schedule today. I’m glad you are here
now. Let’s talk about how I might be able to help you.”
Strategy: Understand that sometimes resistance is patients’ avoidance of what
they consider to be a frightening and/or unhelpful experience. Concretely discuss
the potential benefits of genetic counseling. We recommend doing this at the
beginning of the session.
Examples:
- The patient was referred for genetic counseling late in the pregnancy (24 weeks).
She had an abnormal screening test 2 months ago and did not follow up on the
referral for genetic counseling until just recently. The patient expressed frustra-
tion at her limited options. The genetic counselor acknowledged that the patient
was in a difficult position. The counselor’s empathy allowed some alignment and
also gave the patient time to express her frustration, which helped her move for-
ward in the session.
- A patient came in for a consult prior to an ultrasound for evaluation of possible
intrauterine growth failure and said, “I don’t see why I have to have a consult.
I’m not having any testing.” The counselor explained that a consult was being
done so the patient could understand the potential outcomes of the ultrasound.
The genetic counselor also explained that if problems were identified, she would
be available to help review options so the patient could make informed
decisions.
- Often families have the impression that a genetic evaluation will always involve
genetic testing, which they may perceive (for whatever reason) as a negative
experience. When the counselor explains that the process will involve gathering
information, obtaining a history, doing a physical exam, and then considering or
discussing testing if applicable, their resistance often disappears.
9.1 Patient Resistance
