FROM THE PRESIDENT by Thomas Higgins, MD, MSPH, MBA
Empowering Patients Through Better Communication
Do you recall the humorous Monty Python skit“ Argument Clinic,” where an unsuspecting customer seeks a straightforward argument but ends up in a bizarre exchange of contradiction?
A man enters a clinic to buy an argument. He’ s sent to the wrong room first, where he’ s told he’ s being“ contradicted.” He insists,“ No, I’ m not,” and the other replies,“ Yes, you are,” creating a loop of simple gainsaying. He then finds the correct“ Argument” room, where the“ arguer” explains that an argument is“ a connected series of statements intended to establish a proposition,” not just a contradiction. The customer keeps getting only contradiction in response. They debate whether contradiction is the same as argument. The arguer charges extra each time the minute is up, turning the whole thing into a bureaucratic, pay-per-quibble service. The sketch escalates into absurdity: the man complains he’ s not getting a proper argument; the arguer retorts that he is; they go in circles over definitions, payment and timing.
This sketch highlights the absurdity and frustration that can arise from poor communication and empty debate, where argument is reduced to reflexive contradiction.
Does this sound like a discussion you have with some of your patients?
How about when you talk about the importance of vaccination to a parent who regularly listens to podcasts that insist that vaccines cause all kinds of unsubstantiated problems? Or when you explain why an antibiotic is not necessary for a common cold?
I find myself getting caught in conversations with patients that feel like they are headed toward an“ Argument Clinic.” If I can catch it early enough, I reconsider my approach( sometimes even literally leave the room to reset the situation). Some patients have a preconceived explanation of their problem and an expected plan of treatment, which can lead to frustration, confusion or a simple“ no” in response to a carefully reasoned recommendation. While such a response could be chalked up to stubbornness, it often reflects fear, past negative experiences, misinformation, cultural beliefs or a mismatch between what physicians say and what patients understand or value.
When patients appear to contradict our care advice, we have a choice: view it as a communication breakdown requiring more persuasive tactics, or as a rational response to systemic flaws. If we choose the latter, we can then redesign our approach. In this context, a patient’ s refusal serves as valuable feedback, indicating a mismatch between the provided care and their individual risks, resources and experiences.
We can’ t win the argument, but we can build a path that patients may want to follow
The Monty Python sketch ends with a chase down a hallway of doors, each labeled with another service sold by the minute. Our goal should be the opposite: fewer doors, fewer clocks, fewer transactions, instead more continuity, more clarity, more shared decisions. Then the conversation won’ t be a simple paid quarrel; it will be a plan that makes sense to act on, because the system around it finally makes sense.
Reflection before correction
I think it is important to reflect on the patient’ s feelings before correcting facts. I use“ I” sentences a lot:“ I can see why that’ s worrying.” And then I ask permission to discuss concerns and use motivational interviewing techniques to explore values and goals.
“ I can see why that’ s worrying for you. Thank you for sharing that with me. Would it be okay if we talk about a few of the specific concerns you’ ve raised?”
The act of acknowledging that it makes sense to have concerns changes the dynamic of the conversation. Instead of being adversarial, we are aligning on a shared understanding. This builds trust and shows empathy.
Stories have power
While we can’ t expect to win over everyone, making the conversation personal can help. Patients respond to narratives in ways that statistics alone often fail to achieve. A brief, honest story about another patient( kept de-identified and respectful) or even a short personal anecdote can humanize the issue and illustrate trade-offs in a concrete way. For example, I recently cared for a young mother who was uncertain about the influenza vaccine. She was worried about side effects because of things she’ d heard online. We talked about what mattered most to her: being there for her children and family. We discussed how avoiding the vaccine could increase the chance she would be out of work or sick when they needed her. She chose vaccination because it felt like the best way to protect her ability to care for her family.
Stories like this do a few things: they validate emotions, model the decision-making process and show outcomes in real-world terms.
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