Montreal, Quebec — Physicians who manage chronic disease are bearers of a seeming endless onslaught of bad news. The diagnosis is just the start of it, followed by year after year of missed diet and exercise goals, treatment failures, and progressions both large and small. As hard as it is for the patient to hear the news, it’s the physician’s frustration that can seem almost palpable. She prescribed treatment and lifestyle changes, but her patient just didn’t stick with them. Again.
Delos Cosgrove, MD, CEO of the Cleveland Clinic, said it like this in a recent post, “For too long, healthcare has been something that was done to you. Now it’s going to be something you do for yourself in partnership with your doctor and care giving team. You’ll need to monitor your food input, get exercise, and avoid tobacco. ”No question, it sounds logical. If eating too much salt is making me sick, why wouldn’t I chef up some green veg instead of eating processed foods? A million reasons. All of them part of that endless human conflict between short- and long-term thinking. Each of them a little failure we’ll have to atone for at the next exam.
Tim McCort, one of our favorite contributors, tells a story about how those little failures – and the conflicts they create between physician and patient – can build up and become emotionally debilitating:
A woman living with diabetes showed up for a long-scheduled appointment. The last time she’d seen the doctor, he told her that her diabetes was getting worse and it was time to start insulin and really change her lifestyle.
Today, she had bad news. She hadn’t lost the weight she promised. Again. When the nurse weighed her, she was already in tears. As they talked, she admitted that she hadn’t even wanted to come in today – she had tried to make changes, but failed herself and her doctor again.
The nurse caught the doctor in the hallway before he went into the exam room and explained how upset their patient was.
When he entered the exam room, the first thing that doctor said to his patient couldn’t have been more unexpected: “I have some good news, you didn’t gain any weight since the last time I saw you. I prescribed you a medication that makes most people gain weight and you didn’t. Good job.”
That conversation could have gone the other way with more tears, more disappointment, more failed promises. Instead, it created a moment of new hope. The patient felt like she had momentum and the ability to do more. And, I’m guessing the physician felt pretty good about the prospects for their next conversation.
We talk a lot about asking people to make big changes, one small step at a time. Our next opportunity is finding ways to congratulate them for each little victory and creating those “good news” moments that not only change a conversation, but can change the relationship between doctor and patient.
Posted by: Leigh Householder
