practice partner
tain needs and wants, and neither party always
gets their way?
Dr. Berger: There are negotiations. This happens a lot.
Just yesterday, there was a patient with diabetes who
takes insulin injections several times a day. We negotiated that she would stop one mealtime injection and in
place of that re-start her long-term insulin.
Dialogue: In other fields where people serve the
public, part of a communications strategy is the
idea that the customer is always right. Some
people talk about patients as health-care consumers. You dislike that model. Why?
Dr. Berger: I think it’s misleading and incomplete,
and that’s being generous. Last year I went to a medical
conference that had, as its theme, that the consumer is
king or queen, and should be the centre. I agree patients
should be at the centre. The problem with the model
is consumerism works by convincing people they need
to buy something. In health care, we’re trying to help
people, often by convincing them they don’t need what
they think they need. We have a responsibility that goes
beyond delivering a concrete thing.
Dialogue: Communications wraps around the
care you’re delivering. How does emotion fit in?
Dr. Berger: My mentors in doctor-patient communications emphasized the emotional and empathetic. You’re
going to help a patient to be a better communicator too
by acknowledging the person and creating a safe space
to talk.
Dialogue: There’s a patient’s emotions, but does
the doctor’s also factor in?
Dr. Berger: If you involve yourself emotionally, you’re
going to make a mistake. But you can have a level of
mindfulness about what emotions you’re feeling.
Dialogue: Does acknowledging those emotions
alter how you communicate?
Dr. Berger: I saw a patient the other day, a lady in
her 70s. She’s concerned about heart disease and takes
blood pressure medication. It makes her dizzy. She
said it’s okay because the label calls dizziness a side effect. She thinks it’s a sign the medication is working. I
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acknowledged that I was getting frustrated with her; I
don’t want her to fall and break a hip. I think I said “I
really care about taking good care of you, I don’t want
anything bad happening to you.” I eventually wrote a
new prescription for a lower dose. But that’s part of the
relationship.
Dialogue: Disagreeing is also part of the conversation with patients. How do you do it artfully?
Dr. Berger: A patient asked for a medical waiver not
to get a flu shot. They work in a health-care institution
and it’s required. They had a bad reaction once. I said “I
respect your knowledge about your own body and your
concern, but I won’t call that a medical reason and grant
an exemption. I hope I’m not disappointing you.” So I
acknowledged their feelings.
Dialogue: When you’ve been on the other end,
as a patient, how do you assess the communications of your doctors?
Dr. Berger: One of our kids had a GI issue. Not major,
like life disturbing or threatening, but a chronic issue.
We really discovered what it meant to be poorly communicated with. We got the brush off. It made me feel
like they were being algorithmic. They checked the
boxes: it didn’t work, and now we’re referring you.
Dialogue: There are times in encounters with patients where doctors just don’t know the answer
to the problem. With open communications, can
those instances actually help to strengthen trust
and the relationship?
Dr. Berger: A resident came up to me once when I
was preceptoring to look something up on the computer. I said, “Why are you looking it up here and
not in the room?” He didn’t want to look it up in
front of the patient because he was concerned about
the patient’s expectation that doctors know everything.
When you say “I don’t know” I’m sure in some cases you lose trust. But you’re also worki