Teaching Exercise: Having an In-Reach Discussion

Teaching exercise: having an in-reach discussion

Below are two examples of in-reach discussions at Mrs. Johnson’s annual comprehensive care visit. Read and discuss which version your team prefers.

Example 1:

Diana (MA and panel manager): Mrs. Johnson, my computer tells me you’re due for colorectal cancer screening. After your vital signs I will arrange for you to get that screening done.

Mrs. Johnson: Okay.

Diana: You either need to put a stool sample on these three cards and bring the cards back to the office, or if you would rather have a colonoscopy, I can arrange it.

Mrs. Johnson: What is colorectal cancer?

Diana: Don’t worry about that yet. Let’s just do the fecal occult blood cards. Here they are. Read the directions and bring them back next week.

Mrs. Johnson: Okay.

Example 2:

Diana: Good morning, Mrs. Johnson, how are you today?

Mrs. Johnson: I’m okay, thank you.

Diana: That’s good. I’m happy you are here. Let’s take your vital signs. Now I’m wondering if it would be okay to talk about preventing cancer of your colon. How does that sound?

Mrs. Johnson: That would be fine.

Diana: What do you know about colon cancer?

Mrs. Johnson: I think it’s cancer in my intestine. Do I have it?

Diana: We don’t think you have it, but we have a test to make sure. And you are right about what colon cancer is.

Mrs. Johnson: What kind of test is that?

Diana: There are two choices, and I’m going to read information about these choices from this information sheet our doctors have written. [The information describes fecal occult blood testing and colonoscopy]. Which of these tests you would prefer to do?

Mrs. Johnson: I’d rather take those fecal blood cards home and do that.

Diana: Great. Here are three cards. [Diana reads the details of doing fecal occult blood testing from the information sheet and answers Mrs. Johnson’s questions]. Do you think you could bring those cards back to me by the end of next week?

Mrs. Johnson: Yes, I will bring them back next Friday.

Diana: Excellent. I’ll get the doctor to come see you now.

After reading and discussing these in-reach examples, find a partner and practice having an in-reach discussion about having a colorectal cancer screening. Switch roles so that both people play the role of panel manager. Discuss the successes and challenges of the conversations as a group.

Source: AMA. Practice transformation series: panel management. 2015.