PRACTICE PARTNER
time and is bad
medicine for you.”
The advice for
patients was to
prepare, be concise
and be accurate –
the nature of the
health issue, when
it started, what
makes it better or
worse, what might
contribute to it, etc.
Where does the responsibility rest? Yes, patients should
be open. Yet despite the yearning for collaboration,
patients are sometimes reluctant to share the ideas that
can provide vital clues. They might worry about what
their doctor will think. They don’t want to interrupt.
They defer to the doctor’s expertise. Or they simply
aren’t asked.
Doctors have a critical role as patient educators. Remember, patients can be physician educators too. Asking them the question directly – what do you think is
going on? – is a starting point for that education about
a possible diagnosis, treatment or prognosis.
Sharing concerns calls for empathy
The Best Health survey revealed that doctors also wish
patients would share what they’re worried about right
away. That pertains to the general health issue, and also
to the related concerns.
The health issue is the fact; the rest is feelings. There are
two elements at play – those feelings need to be explored,
then acknowledged.
Beyond the objective fact gathering, what is the patient’s subjective response? What is keeping them up
at night? What are they angry about? Or fearful about?
Where is their mind racing?
You’ll find different ways to draw out those underlying
worries. The course of action may address those worries,
and that’s important. Knowing the worries might also
help to inform your approach.
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DIALOGUE • Issue 1, 2014
The point is that every worry is legitimate. Their
existence should be validated, whether or not (in your
view), they are warranted.
A recent survey from the Cleveland Clinic about the
doctor-patient relationship found the one thing patients want most from their doctors is empathy. In fact,
patients are often willing to overlook common grievances with their doctor if he or she is empathetic. The
same survey found that when patients aren’t straight
with their doctor, it’s mainly because they want to avoid
being judged or lectured.
Empathy is the ability to understand someone else’s
experience, and communicate that understanding back
in a supportive way. Simple – but not always easy.
One analysis of empathy in the Canadian Medical Association Journal noted a study of oncologists who were
videoed speaking with their patients. Moments when
patients expressed emotions – e.g., “I’ve got nothing to
look forward to” – were tracked. During these “empathic
opportunities,” the oncologists responded in an empathetic way only 22% of the time. Otherwise, they
steered the conversation to another aspect of medical
care, like a change in therapy.
As the CMAJ article emphasized, “Clinical empathy is
an essential element of quality care, and is associated
with improved patient satisfaction and adherence to
treatment.” Probing what patients are most worried
about is a clinical skill, one that will give you the information you need to not only provide care but show
care.
What to expect about expectations
What are you expecting? It’s a tricky question, as those
expectations can differ for everyone. Each person’s
unique nature – their culture and convictions, needs
and desires, values and experiences – can affect their
attitudes around every aspect of their life, including
health care.
That’s self-evident. What matters here is recognizing the
implications for the breadth of cure and care expectations.