I recently filled in for a friend who teaches at a medical school. The curriculum that day focused on professional ethics and the power differential that usually exists between us and our patients. One student asked if physicians needed to maintain the relative power in order to be most effective.
After all, she reasoned, we have information that we want our patients to accept and recommendations that we want them to follow. Doesn’t that happen more efficiently when we are perceived as more learned, or more powerful than our patients?
Physicians are considered to be experts. And in many ways, we are. We usually know more about our patients’ conditions and proven ways to treat them effectively than patients do. But there are things that our patients are more expert at – their bodies, their minds and their lives. Medical care is actually best delivered not by an “expert” who sits on a pedestal, but by a committee or a partnership in which each of us, including our patient, brings what we know to be true in order to fashion a plan that incorporates medical advances and the realities of our patients’ lives.
Most of my patients with symptomatic varicose veins will feel better if they wear compression stockings and exercise regularly. If I simply tell them that, my success rate in getting patients to use these two interventions is less than 10%. Very few patients are excited to wear compression stockings – they are hot and hard to put on. And many people associate exercise with discomfort, inconvenience, and yet another thing to fit into their already-too-busy lives. By briefly explaining why these two interventions will help and then asking why they might not want to implement them or what challenges they might experience, I can facilitate a discussion that will allow my patients to find ways of incorporating my recommendations.
The solutions are frequently simple and engage people in taking greater control over their lives. Sometimes, they even offer additional benefits. One patient realized the only convenient time she had to exercise was at lunch. She invited a co-worker to walk with her and not only got some exercise but built a close relationship as well. Another patient was reluctant to wear compression stockings because she found them hard to take off. She asked her husband, whose health was waning, to help her pull them off every day. By doing that, she gave her husband a role in caring for her that helped balance his increasing dependence.
We frequently feel as if delivering our knowledge fulfills our responsibility to our patients. But if our patient is already thinking, “There’s no way I’m going to do that!” we haven’t really accomplished anything, have we? So, take a moment to ask the other expert in the room – “Why might this be hard for you? What do you think will get in the way of your doing this?” You will be rewarded with important information that will change the way you practice, the way your patient sees you, and the outcomes you observe. Medicine by committee will offer you a richer, more satisfying and more effective experience.