DSHS Team Handles Bad News with Empathy
By Michael Wright
A clinical mindset might help them get through the day, but a clinical approach simply won't work. Not when you're telling people they have a sexually transmitted disease.
It's a paradox the HIV/STD public health follow-up team at the Department of State Health Services faces constantly. The group works with local and regional health departments to notify people who have tested positive for an STD , offer referrals to resources and medical care and confidentially track down and notify their partners in an effort to break the infection cycle.
Oct. 4 is National Disease Intervention Specialist Day in recognition of public health workers’ efforts to deal with STDs across the country.
Often the most delicate part of the job is the field visits to ensure local authorities are following state law. That means knocking on doors not knowing who is going to answer or how they will react and often modeling the proper procedures in the field.
Detachment is necessary to do the job properly. But great empathy and people skills are needed when telling someone he or she is HIV positive. They aren't just messengers, they are counselors and detectives and they need to track down the patient's partners in order to warn them and try to erect a barrier to further spread of the disease.
"There is a really human art to getting people to open up and give all these intimate details of their lives," said Mary Cullinane, an STD nurse consultant. "And the workers have to be sleuths."
Syphilis Elimination Coordinator Sydney Minnerly agrees.
"You have to be empathetic, confrontational and professional," she said.
Once you inform the patient, the next step is to take his or her sexual history. Interviewers try to get names, addresses and phone numbers from people who have just been given bad news and might not want to have anything to do with their former partners in any circumstance.
"We stress confidentiality," said Samuel Goings, a public health follow up consultant. "Then we try different locations to find the partners, bars, parks, even the bushes sometimes."
That requires disease intervention specialists to stay informed about what's going on in the community.
Everyone in this eight-person group has done their time knocking on doors.
Speed is of the essence, especially with HIV. The goal is to notify a patient within seven days of a positive test and get them into medical care as quickly as possible.
"If you get somebody into care and he or she starts taking medication for his or her HIV infection, we often see their virus levels drop considerably, reducing that person’s ability to transmit the infection to others and helping to improve his/her health as well," Minnerly said.
Before they can deliver the bad news, the have to find the patient and it's not always as easy as looking up the address. Some situations call for sensitivity and fast thinking.
"You have to be quick if the grandmother answers the door and wants to know if she can relay the message," Minnerly said.