Some of my favorite conversations with patients are the ones that happen via facial expressions. (See also: the CHF patient who swears up and down that they’ve stuck to a low salt diet but has three boxes of half finished Chinese food next to them…like, sir, why are we lying). Sometimes I can’t help it and will say something, and ironically those conversations usually help with rapport.
(A disclaimer: I usually will take a more thorough social history, and this isn’t supposed to be stigmatizing to people with addictions!)
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