In the course of a day, most physicians will see patients from all walks of life. Their problems will vary in complexity. Some will have simple concerns that require very little time or effort, while others may have diagnoses that are as elusive as they are time-consuming. As physicians, we not only accept that unpredictability, but most of us will actually embrace it. It’s an honor to care for patients, and those challenges are both professionally interesting and personally rewarding.
In addition to the diversity of conditions we treat, we will also interact with patients who have different personalities and philosophies about what health care is. Some people treat health care as a commodity, a product that can be bought, sold, and negotiated. In their view, the physicians who traditionally deliver health care are merely “providers” or even salesmen. These patients may view themselves simply as consumers.
Other patients, however, have a more “traditional” view of health care. Some of these patients may hold their physicians in such high esteem that they may not even question their assessments or instructions. For a variety of reasons, these patients may take a less active role in their care and carry a rather meek disposition.
Most patients fall somewhere in between. As a community of physicians, however, when we talk about patient attitudes, we seem to concentrate more on the consumerist mindset. We bemoan the fact that seeing health care as a commodity erodes the patient-physician relationship; all too often, we forget about the meek patients who listen to us, do what we say, and don’t question our “authority.” The meek can be a welcome reprieve from those patients who arrive with their Internet printouts in hand, requesting a specific intervention for their self-diagnosed condition. We may appreciate the pleasantness of the meek, but we must be careful to keep them involved in the decision making process.
Much has been written about the need for patients to take charge of their health. Although concepts such as medical consumerism might take this idea too far, most of us would agree that some degree of personal responsibility is critical to our nation’s health. A variety of strategies can support patient responsibility and should be encouraged; these include researching conditions on legitimate websites, creating lists of questions prior to each doctor visit, and employing a formal patient advocate. As long as these strategies support the patient-physician relationship and do not interfere with it, they can be very effective.
But most of these strategies rely heavily on the patient’s initiative and drive. A preferred model for patient care may be the shared decision making strategy described by Kevin J. Bozic, MD, MBA, and Vanessa Chiu, MPH, in Clinical Orthopaedics and Related Research. They remind us that physicians have an important role as the patient’s advocate and partner. Patients do better and are more satisfied when they are involved in making healthcare decisions.
Recently, my classmates and I participated in a workshop hosted by the AAOS Communications Skills Mentoring Program. One component focused on Culturally Competent Care Education (CCCE). Designed to further develop communication skills and sensitivity to cultural differences, the CCCE covered musculoskeletal disparities, developing cultural competence, and managing unconscious bias. The session used the “Four Es”—engagement, empathy, education, and enlistment—to show how the patient-physician relationship can be enhanced. The program reminded us that caring for patients involves more than diagnosis and prescription; it involves teamwork.
As physicians, we have a wonderful opportunity and serious obligation to empower our patients and affirm their role. As we consider their diagnoses and formulate their treatment plans, we must remind them (and ourselves) that we are a team and that they, as patients, are the most important members. As physicians, we should not only encourage patients to ask questions, we should actually take the time to answer them.
We may lament that the consumerist mindset continues to gain traction in some patient populations and that it can erode the patient-physician relationship. But before we point fingers, we must entertain the notion that some patients may have adopted this approach because we don’t do as great a job as we think we do in including them in the decision making process. We should work with them to restore the team mindset and mend the relationship.
For those meek patients, though, we must be careful. We cannot simply enjoy their “agreeableness.” We must engage, educate, enlist, and empower them to take an active role in their care. If we can establish a trusting relationship, our patients are more likely to adhere to their treatment plans, experience better outcomes, and be more satisfied. As physicians, we will find a new satisfaction in our work and may even face less risk with those patients who experience unexpected outcomes. In the end, it’s not just the right thing to do; it’s the smart thing, too.
James M. Saucedo, MD, MBA, is a resident member of the AAOS at Northwestern University Feinberg School of Medicine. He can be reached at firstname.lastname@example.org
James A. Hill, MD, is a professor in orthopaedic surgery at Northwestern University Feinberg School of Medicine.