What every doctor needs to know

What patients want to know from their doctor

Prognosis

• Will it get better? When do I expect to get better?
• Will it get worse? When will it get worse?
• Will I die? When will I die?
• Will it stop me from doing what I want to do? e.g. occupation, hobbies, recreation, travel
• Is it going to affect my lifestyle? e.g. diet, activity

Side effects / Complications of treatment

• Treatment options
• What are the pros and cons of treatment? Pros and cons of doing nothing?

Why patients don't go to see a doctor?

• Fear that someone else will found out about their illness
• Fear of judgment e.g. obesity, drug addiction
• Fear of the impact on their life (see above)
• Confrontation with mortality

Why do patients not comply

Encounter related:

• They felt railroaded into a specific diagnosis and treatment plan
• They weren't given a range of options

Treatment related:

• too hard to remember (insulin, too many medications at different times)
• too hard to self-administer (medicated body wraps)
• interferes with their daily routine (dialysis)
• has unpleasant physical effects (chemotherapy)
• unpleasant psychological effects (psychiatric drugs)
• leads to dependency (opiates)
• interferes with common human functions e.g. appetite, sexual function (psychiatric drugs)
• interferes with freedom (cancelation of driver's licence)

Expectation related:

• Benefits of treatment are not perceived immediately but all the drawbacks are

Why are patients fearful of hospitals?

• Loss of dignity e. nakedness
• Loss of confidentiality e.g. open wards
• Loss of control e.g. meal times, bed times
• Loss of freedom e.g. detention
• Invasive or painful procedures e.g. venipuncture, endoscopy
• Complications of treatment e.g. major surgery
• Risk of infection e.g. MRSA
• Invasion of privacy e.g. shared facilities
• Fear of the unknown

Different reasons why patients want to see a doctor

• Get treatment (e.g. fracture)
• Alleviate symptoms (e.g. vomiting and gastroenteritis)
• Obtain a diagnosis (e.g. sprained muscle)
• Obtain a prognosis (e.g. post myocardial infarction)
• Obtain supporting medical documentation e.g. sick certificate, insurance policies, welfare payments, travel restrictions, special considerations (e.g. reinstating flying licence)
• Reassurance (that nothing is wrong, it will get better or no special treatment is required) e.g. common cold
• Any or all of the above

Why patients don't get along with their doctor

• Poor communication
• Unrealistic patient expectations

Examples of poor communication

• Rushed or cursory assessment without explanation of the diagnostic process
• Not listening to the patients account of their illness
• Not acknowledging the patients needs or requirement when developing a management plan
• Not addressing the original reason why the patient sought consultation e.g. given a diagnosis but not a prognosis (see above)
• Lack of explanation of the treatment options e.g. surgery versus plaster
• Lack of explanation of the disease, complications and prognosis

What do we need to know about our patients?

• They are just like us (and doctors make the worst patients)
• What sounds easy and obvious to us is not so easy to accept by them
• They are scared of what could happen or will happen (e.g. angina and coronary bypass operation)
• They would like to trust you but they won't give it away without good reason (e.g. common cold and withholding antibiotics)
• They don't want you to abandon them half through the assessment and treatment process when things go wrong (e.g. complications of major surgery)
• They need some time to be able to share your confidence and optimism (e.g. cancer diagnosis)
• It's actually quite hard to break most people's trust but beware if you do

What can doctors do?

• Show Empathy
• Use appropriate language (according to culture/sub-culture, education and intellect) and avoid 'medicolese'
• Acknowledging the patients requirements (including those who relinquish all control to you)
• Explain all points of the diagnostic and treatment process (including how long it will take)
• Recalibrate a patient's expectations to what is possible rather what they imagine
• Give options
• Recruit as many resources (informal and formal) that can help patients get through the motivational, emotional and practical aspects of management.
• GIVE PATIENTS SOME CONTROL AND PREDICTABILITY OVER THE SITUATION (what do you think you can accept or manage at the moment)

Things to do if a patient doesn't listen to you

• DON'T TAKE IT PERSONALLY and BE PATIENT
• Review reasons for non-compliance and address them
• Work a compromise and accept a less than ideal option
• Think about incremental, easily digestible changes over time that are tolerable rather than radical changes (not "my way or the high way")
• Be prepared to walk away and agree to disagree if you can't resolve the matter (as long as the patient is mentally competent)
• Refer to a second opinion or a colleague's opinion
• Be available if a patient changes their mind