Talk to Your Doc to Avoid Cookie-cutter Care

Does your doctor know what you want?

Doctors generally lack a good understanding of their patients’ beliefs and desires–but the doctors’ knowledge improves a lot when patients ask questions and discuss their preferences.  So says a study published last month in the Journal of General Internal Medicine, summarized in ScienceDaily, and brought to our attention by a kind reader.  (Thanks!)

The study examines more than 200 physician-patient encounters.  It was conducted by Richard Street of Texas A&M University and Paul Haidet of Pennsylvania State University.

two physicians grab a patient's chinLike most advocates of better physician-patient communication, Street and Haidet call on physicians to ask patients for their views.  For decades, such advice has been falling on doctors’ mostly deaf ears.  A patient who wants to be heard probably has to take the initiative. That’s the main point of this blog–and our book.

Conversation between the physician and patient is an essential element of care that is “personalized” or “tailored” or “patient-centered”–all terms that mean just about the same thing.  The conversation doesn’t have to take a lot of time, embarrass either person, or follow a rigid protocol.  And, it sure helps if the patient comes prepared.

Supporting the Street-Haidet study is another recent article–by Ronald Epstein, whom we’ve cited before, and colleagues.  These authors say: “Truly patient-centered care requires knowing the patient as a person and engaging the patient as an active participant in his or her own care.”  To do this, they advocate “shared deliberation,” which they define as “the personalized consideration of each patient’s needs and preferences, which evolve over time.”

Conversation of this type is practical and not very difficult.  It cuts through the maze of bureaucratic efforts to build up patient “autonomy” and promote patient “choice.”

In general, these bureaucratic efforts haven’t been very successful.  As Theresa Drought and Barbara Koenig noted several years ago, patient choice is limited by a lot of factors, such as insurance incentives, the patient’s feelings of vulnerability, and the biases of the physician presenting the choice.  (Another reader reminded us of this landmark article.  Thanks to you, too!)

While policy-makers dither and researchers investigate, patients continue to face real-life dilemmas.  Often they will find their doctor to be an empathetic and willing listener, once the patient begins to talk.  Let’s build up physician-patient communication one conversation at a time.

Take care.

Photo credit:  Seattle Municipal Archives.  Attribution.

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