I remember once encountering a patient who refused to have a much-needed CT scan. I sat down next to her to try to coax her as much I could, all with no success. Admittedly I was a bit annoyed, so I put it straight:
‘If you don’t get this scan done, we won’t know what is wrong with you and worst case scenario, you could die’
Sure enough, it turned out she was anxious because she was claustrophobic. Xanax didn’t help, but armed with my newfound knowledge, I walked her down to the scanning room. I stayed with her to reassure her until she got her scan; a great outcome for all involved!
For a while during that encounter, I downplayed the potential consequences of her decision. I avoided being direct because that would be uncomfortable for her. Or at least that is what I told myself. In reality it was uncomfortable for me and that was the real problem. For most people, we avoid difficult conversations with patients because they are uncomfortable. No one wants to be the bearer of bad news. But as I’ve learned since, confronting those difficult issues head-on will make you a better doctor.
How difficult conversations will make you a better doctor
How does this happen? Difficult conversations give you an opportunity to explore a part of a patient’s problem you might be unaware of. You will never know if your patient doesn’t take their medications because he/she can’t afford them, if you avoid that conversation. The knowledge I got from that conversation with ‘patient x’, is what helped me help her. If you never find out the root cause of your patient’s problem, you will continue to hack away at the leaves and wonder why you are getting nowhere.
‘If you never find out the root cause of your patient’s problem, you will continue to hack away at the leaves and wonder why you are getting nowhere.’
Remember, most of the time, patients trust you. As you confront difficult issues honestly, you will strengthen your patient/doctor relationship. Their trust grows and potentiates the impact of whatever advice you have to give. So the next time you are thinking of avoiding a difficult conversation with a patient, think of it as an opportunity to become a better doctor. An opportunity to discover the answer to a complex problem. It can be hard to do at the end of a long day when you’re tired and just want to go home, but it can make all the difference.
Here is a helpful approach for engaging in difficult conversations with patients from an article in the GMC blog.
