The topic for today’s post is responsibilities and there are various aspects, which can pertain to this for both practitioners and patients alike. While many things are important I do believe that honesty and communication are either near or at the very top of the list, quite possibly accompanied by trust. Without trust, communication, and honestly there is little chance you will achieve what you set out to accomplish regardless what you may attempt to accomplish in life. While these should typically be implied let’s explore them a little bit to clarify precisely what I am referring to.
Let’s start with trust. When either a patient or a physician meet each other for the first time, there is only an implied trust that the physician will do no harm and that both will communicate with each other openly, honestly, and effectively. However, as the visits continue you may develop a deeper trust and discuss things more openly than you first felt inclined to do. This is normal in any relationship whether in healthcare or otherwise.
In healthcare as in any relationship between two people once that trust is breached, it can and often is nearly impossible to rebuild the same level of trust. Either party can breach trust in a variety of ways. It doesn’t matter if it is intentional or not, but failure to communicate is often the most cited reason that patients report that they lose trust in their providers. However, physicians can also lose trust in their patient when they fail to disclose pertinent details during the course of their care.
I once was the unfortunate recipient of an accidental narcotics overdose due to a mistake during a procedure. I trusted that the physician had no intent to cause harm, and to put it simply, mistakes happen. While it had the very real potential to have killed me, it was treated immediately upon the physician discovering the nurse’s error, and I was treated appropriately to avoid subsequent respiratory arrest. Sure I spent a few days in the hospital in an ICU but again I felt he was sincere when he visited me to discuss it, and we had always had a great relationship to that point in time, so I continued to see him as a physician.
Fast forward two years and a few days, and suddenly things changed between us. He was more distant and even accused me of misusing my medication. Suddenly there was huge tension every time he entered the exam room, and soon thereafter I was told that he would no longer treat me as a patient. In hindsight I should have seen this coming since the statute of limitations on medical malpractice suits to be filed was two years at that time. I grant you that this is a very drastic example of the loss of trust between provider and patient, but it is a real one. Many more subtle things can breach that trust between both parties, but the end result is the same. That relationship will never be what it once was.
Conversely, I have several physicians currently that I have ultimate trust in their abilities and never hesitate to discuss even the most sensitive of topics. I also have other physicians who seem to always be too harried to really listen to the answers to their questions, or what I may be relaying to them. Over time you learn what your relationship with each practitioner is going to be. They will not all be as comfortable as each other but you should be able to trust that you are getting the best possible care whether it be diagnosis or treatment.
If a patient is unable to communicate openly and honestly with their provider how can a provider be reasonably expected to make an accurate assessment of the symptoms, establish a diagnosis, and implement a treatment plan? If the physician feels he cannot be honest with you they may not share the severity of the diagnosis opting to address it at a later time, if at all. Just as no two physicians are alike, neither are any two patients. Neither one of us should judge each other purely based on our previous experiences. I think that type of judgment, whether conscious or unconscious, can sabotage the provider / patient relationship.
Hand in hand with communication and trust comes honesty. If a patient doesn’t feel they can be honest with a physician then potential important information may be left out that could help lead the physician to a proper diagnosis or treatment. Similarly, if the physician feels that they cannot honestly discuss some of the challenges involved in the patient’s care then, here again, there is an impediment to the relationship.
Maybe the subject matter is sensitive, or you are embarrassed to have to admit something. Trust me when I tell you most healthcare providers have heard most of what you could throw at them. I won’t say you’ll never shock them, for I’ve encountered some things as a provider that have shocked me, but I tried incredibly hard (and I would like to think I succeeded) in never letting the patient know I was taken by surprise.
Maybe the physician is delivering a devastating diagnosis and in order to soften the blow, they decide to leave out the fact that it is very often untreatable, only able to attempt to mitigate the symptoms, not the illness, and that the diagnosis and underlying illness is invariably fatal. While it is true that they may be softening the blow by not telling the patient that they are in fact terminally ill wouldn’t you rather know the truth? By knowing the truth you can be better equipped to have those hard discussions about treatment options, quality of life, advanced directives, and try to prepare yourself and your loved ones for the inevitable result.
While the above discussion may sound like a whole heap of negativity, it really isn’t. It is meant to be an eye-opening discussion to make us stop and think about how our actions affect others specifically in the healthcare environment with no punches pulled. On the subject of open, honest communication I feel it is always important to have the ‘uncomfortable discussions’ with those closest to you before you have to.
There are many, many people that receive long-term care against their wishes because they never took the time to discuss their wishes and put them in a legal document, or even discuss them at all with family. When tragedy strikes is not the time to try to stop and think what your loved one would want, yet it is all too often the first time the subject is acknowledged, at which point it is frequently too late. Take a few minutes and have the discussion with your spouse, kids, or close friends and yes even your physicians. Create an advanced directive to relay what your wishes are should you become suddenly unable to speak for yourself.
If you aren’t sure about how to even begin such a discussion, you can visit the website of the CODA Alliance at www.gowish.org and purchase a card game designed to do just that. Help you put your thoughts into words. If you want to check it out before you buy, you can play their free online version of the game, but I urge you to order the card game if you find it helpful. Not only will your purchase enable you to revisit the discussion should your circumstances change, but will also help to keep such resources available for all.
You may be wondering how we got down this seemingly dark rabbit hole. Well, it’s actually quite simple. While this post isn’t about tragedy as you might think by reading it. It is about effective communications between provider and patient, and that includes those close to the patient and addressing what is often the most challenging topic of all, death. I will grant you that this is not what you might have expected in terms of a list of responsibilities. I think the subject is much more complex than a simple list.
Do you have something you’d like to share on the subject? Have you ever had the tough discussion about death and dying? How did you approach it? I can tell you that I have had this discussion on many levels, too many times to count. Maybe that will be another post someday.