Yesterday I missed an opportunity to partner with my patient and engage her in the decision making for her treatment. I did what our kids’ 5th grade teacher warned them never to do – I assumed. I assumed that I knew what my patient would prefer. And, as that very wise, witty (and a bit risqué for 5th grade!) teacher explained, “When you assume, you make an ass out of u and me.” My patient had described her considerable anxiety over having a procedure done, so I decided she would tolerate it better if we staged her procedure, dividing it up into several shorter sessions, rather than performing one or two longer procedures. Fortunately, her kind husband stopped me and turned to his wife to ask her what her preference would be. To my surprise, she said she would rather have fewer but longer procedures. While there were medical reasons to adopt my plan, the important point of the interaction was that I failed to include my patient in deciding the best way to treat her. This one question, “What would you prefer?” could have strengthened our relationship, provided me with important information, and allowed her to feel engaged rather than powerless and, it turned out, even more anxious. I definitely felt exactly as our children’s teacher warned I would! It made me wonder how many times in other areas of my life I continue to operate as if I know what others think.
It took only seconds before that wondering led me to another poignant example.
Years ago, when our daughter was about to enter kindergarten, I took her to a furniture shop to pick out a desk. She was going to school and would soon have homework, and a desk seemed like an important symbol of this new, more grownup status. After I had pointed out several white melamine desks (which seemed very practical to me, as they would go with any décor), she settled on a desk in which the table top was bright blue, the drawers were bright red and yellow and the sides were bright green. I was horrified. This was not my idea of a smart choice. Patiently, I explained that she might like this brightly colored desk now, but my fear was that in a few years, she wouldn’t like it anymore. Her reply is one I have never forgotten: “But if I pick the one you want me to get, I won’t like it from the beginning.” There is no argument to such clear logic, even from a 5 year old. We bought the brightly colored desk, which she happily used for many years.
We all have preferences. A powerful and concise way to tell our patients that we see them as unique individuals and value their input into their care is to simply ask, “what would you prefer?” It’s a new discipline that I’m excited about putting to use in my life.