AD-vice: Navigating Clinician Stigma During Detailing Visits

Curated By: Aanchal Gupta, Program Coordinator, NaRCAD

Tags: Stigma​, Primary Care, Data

Time and time again we’ve heard about the challenges detailers face when tackling clinician stigma. Detailers have shared comments from clinicians such as, “We don’t take those types of patients” or “I don’t want to be known as the gay doctor.”
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Addressing stigma and fostering understanding with clinicians can often feel overwhelming for detailers. In this edition of “AD-vice” we shine a light on these issues and share experiences from our community on how they managed stigma during detailing visits. 

Understanding Stigma
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• “Whenever I address something uncomfortable with a provider, stigma or otherwise, I try to create an environment where we can work collaboratively on the issue and the provider feels as though I am a resource for them. – Jessica Alward, MA, New Hampshire Bureau of Infectious Disease Control

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• “One of the biggest myths about stigma is that some people carry it, and some people don’t. However, stigma is not binary, and we all possess the ability to stigmatize another group that we perceive to be an ‘outsider’ group. Historically, stigma has appeared mainly in the form of social inclusion, with those identified as ‘others’ being treated as societal outcasts.” - NaRCAD

 

• “Imagine that the clinicians or people you detail hold stigma not because they want to stigmatize others, but for some more relatable reasons: they’re impressionable, they’re naïve, they’re vulnerable. In the same way that a clinician wouldn’t expect someone with a substance use disorder to suddenly recover if harshly confronted, we can’t expect the person who stigmatizes to respond to similar tactics.” – Zack Dumont, BSP, ACPR, MSPharm, RxFiles Academic Detailing Service

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• “Stigma isn’t something that folks are actively choosing, it’s more of what they’ve been taught. Changing that culture of practice is much more difficult compared to asking prescribers to prescribe cholesterol-lowering therapy. There’s very little societal baggage when it comes to improving cholesterol than there is when it comes to destigmatizing addictions or chronic pain.” – Andrew Suchocki, MD, MPH, Clackamas Health Centers

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Addressing Stigma through Education and Conversations
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• “We’re approaching [stigma] with education and lots of conversations, since we’ve found that helping our staff to get a better sense of addiction as a disease is really invaluable to making them more open to [medications for opioid use disorder (MOUD)] and treating people with opioid use disorder (OUD).” – Carol Furlong, LCMHC, MAC, MBA, Elliot Hospital

 

• “When we detail in groups, we focus on small group discussions. One method I use involves flashcards with myths or biases about OUD, and asking two or three of the attendees to discuss that amongst themselves. We have also used a language sheet that guides providers in what to say.” – Elisabeth Fowlie Mock, MD, MPH, Maine Independent Clinical Information Service

 

• “A lot of the older language around OUD identifies with “bad choices” and “bad people”. For example, relapse is associated with a fault of the person. When we are talking about a person with OUD, we are talking about someone with a disease and relapse is a natural course of the disease. When a patient’s blood sugar goes up, we don’t call it a relapse. Just like people with diabetes, we will never cure a person with OUD, but we help them manage [it].” – Don Teater, MD, MPH, Teater Health Solutions

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Addressing Stigma through Data and Resources

• “Our team provides statistics that relate to the provider’s specific neighborhoods and specialty, giving them real-time pictures of what’s happening with the patients they see. We know that [cocaine use] is still a difficult topic to bring up, so we help address this with our action kit resources on stigmatic language and counter-top brochures that signal to patients that the provider’s office is a safe place to discuss these issues.” – Carla Foster, MPH, New York City Department of Health and Mental Hygiene

 

• “Know your patient population: Understand who the patients are, the trauma they’ve faced, and the stigma they may endure. Look at the experiences of your team, the clinicians, and the patients you’re working with and try to understand how these different perspectives all influence one another as you develop your resources.” – Trish Rawn, BScPhm, PharmD, Centre for Effective Practice

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Our team at NaRCAD is here to learn and support you as we combat stigma and continue to promote inclusivity. Check out our new Healthcare Inclusivity Toolkit for detailers for additional resources. 

Best,

​The NaRCAD Team