The good physician treats the disease; the great physician treats the patient who has the disease- William Osler
As patient care becomes increasingly demanding, sharing the responsibility with the patient is an idea good doctors are happy to welcome. In the past , the tools for patient engagement were very limited. However, in the networked era that we currently live in, this approach can benefit the patient greatly.
Doctors should make sure their patients are aware of the pros and cons of a particular procedure before they are asked to select a treatment option. Similarly, patients should not expect their doctors to spoon-feed them, and should come armed with a list of doubts and questions for their appointment with the doctor.
Doctors respect patients who want to take charge of their health. This approach enhances patient safety, and patients are then committed to complying with the doctor’s advice, as the treatment plan has been formulated after taking their preferences into consideration. This buy-in from the patient ensures compliance.
Patients now have access to a range of decision-making aids such as information leaflets, pamphlets, videos, or web-based tools. These explain the procedure in detail and patients get a better understanding of the various options available to them. Health Decision Tools are available free at https://www.healthlibrary.com/healthwise. Mayo Clinic calls them Wider Choice Tools (https://shareddecisions.mayoclinic.org) while Cardiff University has developed option grids (https://www.optiongrid.co.uk/) The website at https://decisionaid.ohri.ca/AZinvent.php has a complete list of patient decision aids. These tools reduce the doctor’s consultation time, help the doctor to honor the patient’s preferences, and allow shared decision-making, where both doctor and patient participate in making medical decisions.
Doctors can use the 5-step SHARE Approach for shared decision making.
Step 1: Seek your patient’s participation
Step 2: Help your patient explore and compare treatment options
Step 3: Assess your patient’s values and preferences
Step 4: Reach a decision with your patient
Step 5: Evaluate your patient’s decision
These are tools doctors and patients should be using regularly. They can clear the brambles of miscommunication and misunderstanding from the patient’s path, and help doctors and patients build stronger relationships. If doctors want their patients to become willing partners in the quest for safer care, they need to help them to speak up.
When patients ask questions, they should receive a “Thank you for reminding me” or “I’m glad you asked” as positive reinforcement. The patient-physician relationship is a sensitive one and has to stand on a strong foundation of trust, honesty, respect and commitment. For this partnership to work, it’s crucial that the physician understand the patient’s expectations; and to maintain openness and transparency in communication from the very start.
When it comes to managing chronically-ill patients, compliance emerges as the biggest challenge. However when patients proactively take charge of their health, there is a distinct improvement in their condition. Today, well-informed patients use mobile health apps to set reminders for medication and don’t miss their doses or crucial appointments.
Apps for managing chronic illnesses such as asthma and diabetes have been proven to improve the quality of life for these patients, allowing them better control of their disease, which is why progressive doctors are happy to prescribe these.
What can patients do?
Patients too need to do their bit and:
* Understand the doctor’s limitation in terms of his ability to help a patient – doctors are not omnipotent
* Learn to trust a doctor for his professional expertise
* Appreciate the fact that he may be overworked; he is human too and can sometimes snap for no evident reason
* Have realistic expectations of the treatment. Doctors are not magicians, and it can take time for the treatment to act
* Do their homework independently and try to find out more about their medical condition- this makes it easier for the doctor to explain the various medical procedures and options they can explore together
* Keep the doctor informed about any changes in their medical condition. Doctors are not omniscient!
* Comply with the doctor’s medical advice
What can doctors do?
* Be polite, considerate, honest and patient
* Treat patients with dignity – not just as a medical statistic or another case
* Respect a patients’ right to privacy and confidentiality
* Support patients in caring for themselves
* Provide them with information and access to credible sources of medical information
A good doctor must not only be a skilled clinician, but he has to take his excellence one notch higher, by keeping an open ear and learning how to empathize. He should constantly try to improve the quality of the medical services he provides, and have the courage to own up to a mistake when something goes wrong and a patient suffers. The doctor-patient partnership is based on mutual respect. Both need to be accountable and responsible; to themselves and to each other as well.