A pitfall of patient-centered communication

I’ve come back from physician visits without a clear idea of what my physician thinks. I think I’ve found a problem, and I believe it’s communication. 

The push to be patient-centered and take all patient preferences in to account has morphed in to a wishy-washy communication style which boils down to the clinician saying “Well, whatever works for you. What do you want to do?” This, in turn leads to conversations at home with spouses and friends of “I don’t know, I wanted my doctor’s professional opinion and they told me I could do what I want. They gave me options but not direction”

This is not good for the patient. The correction away from paternalism, and towards taking patient preferences in to account, to allow shared decision making has clinicians on edge about making professional statements about the next options. I want to know what you think. Then I can bounce that off my own preferences. Don’t take my preferences in to account before you give me your opinion.

If you give me your professional opinion, we might disagree. So there is risk there, in today’s world. That does not help your Google reviews, or Yelp status. If you give an opinion you might loose me as a patient, or I might say “all you wanted to do was give me medicine!” So you couch your answer and say: “Well, you could do this, or maybe this, it’s up to you, you let me know.” This might work well with some things (“would you rather complete deadlifts of glute bridges””) but not others (“we could do another imaging test and see, or you could have this procedure, or wait to have another test”).

How about you give me some data, some outcomes percentages, some risk and benefit data. Then state what you think my next step should be. I can shop to the next clinician and she can tell me her ideas. Then I’m informed. Now I can use my preferences.

It’s patient centered to give people the facts, and to give them your view of the situation.

As clinicians we are perhaps concerned about alienating the pro-magic essential-oil crowd, or alienating the pro-procedure give-me-all-the-things crowd, or the I-already-know-what-I-want-from-you crowd. The Alternative “Medicine” provider does not shy away from recommendations. Professional science based practitioners should not either. We need to speak and explain what we think. Sorry, you might loose a patient if your plan does not fit with them.

I’m not purporting that the conversation end after you state your case. I would like to see a swing to a fearless conversation on both sides of the patient and clinician interaction in an honest and safe manner. Not all health care decisions are easy, so there is certainly room for grey areas and contemplation, but I’d like to know what my health professional thinks. And we should apply this to our own clinic

So work on this next week as a clinician. Strive to state you case, then find out what the patient thinks about it. They’ll appreciate your position and appreciate you asking them their thoughts. 

That’s my position. Thoughts welcome.

–Matt D

PTBrainTrust affiliated Special Continuing Education Deals for our readers: through the Link Above!