People don’t seek care for symptoms alone. People seek care for symptoms plus concern.
A person seeking care often comes with a theory about what’s wrong and may have most of their hope pinned on a specific approach to fix it–for instance, “My back is damaged” and “my only hope is to do an MRI, find the damage, and fix it.”
Expert advice that contradicts a person’s “thought as fact” and “only hope” scenario may be an affront. More than a disagreement, medical disputation of this sort is an assault on the patient’s worldview, and perhaps her future.
Any attempts to try to direct a patient–to try to talk them into or out of something–may seem arrogant, dismissive, and belittling. A confident dispensing with what a patient may see as their only hope may feel hurtful.1
Begin with active, empathetic listening;
Get to know a few things that make that person special;
Elicit patient beliefs and questions;
Summarize and legitimize their concerns;
Use non-technical language and pause for questions between points;
Focus on creating a partnership;
Have “scripts” for common scenarios, e.g.: patients seeking antibiotics, patients with limited life expectancy, and patients with pain seeking pain meds.
These skills capture many of the techniques of motivational interviewing. For more information on this technique check out this resource.
Developing scripts for high-value care may be similar to how palliative care experts have addressed communication around end-of-life issues through developing straightforward, reassuring common phrases, and relying heavily on questions.1 These techniques for end-of-life counseling are now widely taught in medical training, as well as through a series of communication courses aimed at practicing physicians.
We can similarly develop scripts or talking points for common scenarios related to overuse:
