Partners in Care:
or their motivations. Boy, did we give it a pretty good go at trying to stop smoking, and yet we still have providers themselves who smoke. It just isn’ t as easy as it seems to follow the evidence.
But this article isn’ t about vices or motivation, it’ s about letting the patients decide what is right for them at the current time. It’ s about presenting them with reasonable options( even if they aren’ t picking what we would choose) and giving them the time to pick it. Choosing to do nothing, expectant management, while they think about their choice, is still a choice!
I started to hone my skill of writing upside down while I was a math teacher. My 5’ s still look like S’ s no matter right side up or upside down, but that’ s a story for another day. I use this skill daily in the office. Abnormal uterine bleeding is very common in my field and typically has many possible treatment options. I will write the options for treatment on a notepad in my lap in front of the patient as I talk to them. I list each choice starting with expectant management as their first choice every time. I think this helps multiple ways:
- Has her think about the risks and benefits of doing nothing different at all.
- Establishes that I am not here to just prescribe a drug or to cut her.
- Lets her go home with the paper to think about the options and discuss with family and friends.
- Lets her take time to look things up on her own( hopefully skipping Gwyneth Paltrow’ s Goop page).
I draw pictures for them if it helps, asking for forgiveness in my art skills. I wait for them to think for a couple of minutes and then ask them if they know what they want to do or if they need time to think about it. I do not require an extra visit for them to tell me their choice as I make clear in my note that they had options we had discussed, and they would let me know what they wanted.
This shared autonomy is not as easy in application as it seems. Many patients are not prepared to have to choose for themselves. They would flourish in the more paternalistic form of medicine we used to have. They don’ t want to have to choose and therefore be responsible for the outcome. Sadly, I think the size of this group of patients is becoming larger. They often ask me what I would do. I respond by letting them know I won’ t answer that as it isn’ t my body or life that is being affected, and it wouldn’ t be me taking the risks so they need to choose for themselves. Option number one is picked most often by the end of the visit. Most of those will let me know a choice within a week or two. Out of the remaining“ do nothing differently” patients, some will ultimately decide their bleeding is not bad enough to assume the risks of any choice other than waiting it out.
I get the most satisfaction out of those, not because they were miserable and too afraid to pick something( those patients will pick something eventually), but because their bleeding wasn’ t bad enough to treat. Uterine bleeding is sometimes as hard as pain to measure. We try to quantify their bleeding with questions and hemoglobin values, but their perception of their bleeding can still be difficult to capture. I had a third-year medical student watch their first vaginal delivery with routine blood loss and they remarked how much blood there was and asked if she needed a transfusion. I internally giggled.
When we are nearing the end of our time, I touch the patient’ s knee while I let them know that they can take as much time as they need to find the right choice for them. I reassure them that they will be able to make a choice( reminding them expectant management is choice number one). I do this without rushing them, having given them the service of my knowledge in an unhurried time setting as an act of gift giving.
I didn’ t just start doing this one day. It has been a refinement over the years as more and more options to treat uterine bleeding are available. Does this take us over the 15-minute slot? Sometimes. Sometimes not. I don’ t list unreasonable or contraindicated options. I don’ t leave out guidance of what they have already tried or what has already failed as we go through the list. There are times that it might seem like I am leading them to at least a couple of different options. I do this to avoid wasting time, money, pain, suffering, etc. as a result of a fear the patient may have over a particular choice. But, in the end, I support their choice and move forward. They are, after all, paying us for our knowledge and time.
My puppy, on the other hand, requires way more time and I’ m here for it. The pet therapy is working! Find your love language. Remind yourself that your patient’ s language might be different from yours. Shared autonomy with the patient is not always easy, but I believe it is better for the patient. One of my pearls is“ no regret medicine.” You make the best possible choice with the information you have at the time. They can ultimately regret the choice they make for themselves, but it is better than regretting the choice you made for them.
Dr. Barnsfather is an OB-GYN with Norton Women’ s Health.
November 2025 15