PRACTICE PARTNER
Dr. Wayne
Weston
sions based on partial evidence, judging based
on stereotypes – all can potentially limit
choices or compromise health.
Consider the real-life example of a young
female patient, who went to her family doctor complaining about pain in her lower
abdomen. She had a history of ovarian cysts,
which often have no symptoms. The doctor’s exam suggested a pulled muscle. He
prescribed a pain medication, but to be safe
scheduled an ultrasound. The patient didn’t
say much. The doctor sensed she wasn’t
totally satisfied, but left it at that.
A few days later, he called the patient, who
answered angrily. She had arranged to have
the scan even sooner, and had a procedure to
remove a cyst. “What were you thinking,” she said, “when you asked me
to wait more than a week to
diagnose what I knew would
be the problem? Didn’t you
understand how important
this was?”
The family doctor admits
he hadn’t. He felt he had
handled the visit appropriately from a medical standpoint.
However, he says he did jump to
conclusions.
“I mistakenly assumed her beliefs and
values were the same as mine, resulting in
a communication failure that led her to
seek care elsewhere,” the doctor later wrote.
“From her standpoint, I didn’t view her
problem as particularly significant, nor was
I bothered by a few days delay in diagnosis.
In hindsight, I should have asked if she was
comfortable with the plan and, if not, what
she preferred for follow-up care.”
“If we don’t listen carefully and create a relationship where patients can speak their mind,
we’ll miss a lot,” says Dr. Weston, who chairs
the advisory committee for the Institute
for Healthcare Communication in Canada.
“Our job is to help patients deal with the impact of illness on what matters to them – so
we need to know what matters.”
Dr. Jerome Groopman, author of How Doctors Think, adds this: “Most incorrect diagnoses are due to physicians’ misconceptions
of their patients, not technical mistakes like a
faulty lab test.”
In medicine, assumptions can affect how
you treat your patients in at least the following eight ways.
1
2
Do you understand beliefs and values?
Miscommunication and poor communication
are at the heart of many assumptions, says Dr.
W. Wayne Weston, Professor Emeritus of Family Medicine at the Schulich School of Medicine
and Dentistry, University of Western Ontario.
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DIALOGUE • Issue 3, 2014
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P
atients might be too intimidated or embarrassed to pose queries, or the doctor might
not provide an opening. Will patients simply
go along with what you say? Studies show
that a high percentage of patients will not
complete curative medication regimens, follow long-term regimens, or heed advice to
change heath behaviours. One factor is a lack
of understanding.
Lesson: Don’t assume that silence equals
agreement.
I
n a study published in the Journal of
General Internal Medicine, physicians were
asked to complete surveys expressing their
own beliefs and what they thought their
patients’ beliefs were. The answers were
much the same, meaning doctors thought
their patients’ convictions were essentially
the same as theirs. Feeling that you understand the patient’s concerns, goals and
desires can lead you to pursue a certain
course of action – sometimes the wrong
path for the patient.
Lesson: Don’t assume you and your patients are always on the same page.
R
esearch shows that patient-centred interviews take no more time than doctor-centred