The ideal patient-clinician relationship is one of concordance. A shared understanding is developed leading to the patient playing an active part in their care. They follow their agreed treatment plan to achieve the best outcome in the circumstances. If only we lived in an ideal world! Although there are many patients who diligently and effectively implement their plan there are many others who do not.
On our Advanced Patient Communication Skills Course for Doctors we explore the ‘non-compliant’ patient by considering them in three broad categories. Once defined, we then investigate the drivers of each group’s ‘non-compliance’. One such category is the group of patients who ‘know what they should do but choose not to’.
So why do patients choose to dismiss your well-informed, well-intended advice?
There are many answers to that question. Often, it will boil down to a gulf between your patient’s care-plan and their beliefs or desires. Thankfully, drawing upon the work of Groopman and Hartzband can offer clues to help resolve or, even better, avoid such situations. It can be helpful to think of patients in terms of minimalists, maximalists, naturalists and technologists.
At their extremes:
- Minimalists resist and want to avoid interventions, treatment or contact with healthcare professionals
- Maximalists want and even demand attention and action for every ailment – real or imagined
- Naturalists trust mother earth or spirituality to provide the best solution
- Technologists that the very latest man-made inventions, drugs and techniques must be the answer.
If the descriptions above are viewed as two clear dichotomies this leads us to the four mind-sets illustrated below.
It is likely that patients with each discrete mind-set will express themselves differently. The deeper the roots of the attitudes and the more familiar you become with them, the more obvious they become.
- How could you raise your awareness and identify these differences?
- Once you are aware, what will you change about your approach and the language that you use?