It is based on three elements:

1.Everyone wants listening and understanding.

That means that the listener must have listening skills and empathy.
That also means that understanding is required and that agreement is irrelevant.
The mental approach is called ‘unconditional positive regard’. This means the suspension of judgement and ego is needed in order to pay full attention to the other person. Let them tell their story without interrupting or being defensive.  As they talk, you need to communicate your understanding.  Genuine responses that keep them talking.

2. Everyone wants to be valued and included.

Start with the intention that the patient has something to offer.  They have values, wants, and concerns that are valid to them.  They are an expert on their own body and careful listening will reveal valuable diagnostic information and their outcome.  It is incumbent on the interviewer to ask good questions, be curious, and follow up appropriately.  The patients desired outcome is an essential determination.
3. Everyone wants to be engaging in something worthwhile and meaningful. 

Once a patient knows that they are understood, that the outcome they desire is the goal of treatment, and that they will be supported in the effort, they follow through.  The remaining barriers are money, time, inconvenience, and fear.  If they truly believe they are getting what they want, the first three mean much less. 

Fear

Fear is a separate issue to be dealt with.  If trust has been built, it will lessen.  Empathy and compassion help sort out a means of dealing with fear.  All fear must be validated.  The fear is real even if the reason for the fear is obscure. The reason is not relevant. Fear can be very deep seated and may be from a psychological trauma that has been suppressed.  If possible, identify the fear or anxiety producing behaviors or objects.  If they cannot be eliminated then sedation or anesthesia may be the answer.

--Dave

Photo by Dave Hutt, www.dmddigitalphoto.com

Anesthesiologists must develop a thorough history for every patient that is to have anesthesia.  I do one for each patient I see.  I talk to patients and listen.  I hear about fears, surgeries, allergies, medications, diagnoses, treatments, and symptoms. They usually have had appropriate treatment.  Sometimes patients have conditions that are treatable but have not been treated.  Sometimes they are treated too much or in conflicting ways.  Sometimes there is a lack of coordination between healthcare providers.  Sometimes the patient has a condition and they choose not to treat.  If it does not interfere with treatment that I provide, it isn’t relevant. It does make me curious.  Why did they make that choice? They may have made a well reasoned decision. Could it be fear, poor communication, or a misunderstanding?  Perhaps.

Listen Carefully and Be Curious

Almost exactly a year ago, a friend died due to lack of communication between his doctors over a period of years.  Reviewing all the medical records, I can understand what happened.  It seemed that his complaints were not taken seriously.  They didn’t make the diagnosis in spite of symptoms.  He, unfortunately, was not given a choice. 

Proactive Patient

I would recommend to anyone, if your medical problems are not resolving as expected, be proactive. 

If you are unhappy with your treatment, do something about it. 

I would recommend to any healthcare provider to be curious, ask questions, and listen carefully.

--Dave