We know that when patients take more responsibility and initiative, and when they put more effort into improving their health-related habits and self-management skills, things usually improve. Emphasizing how important their role is during every clinical encounter can go a long way to reinforces patient commitment to and improvement in these areas.
The problem is, many patients still expect medical providers to “fix” them. We know that their role has been and should be changing. But this is not always clear to them. In such situations, it is appropriate for providers to seek to alter patient preferences and expectations by explaining the advantages of a shift in roles, however gradual the shift may need to be.
To introduce the topic of mutual expectations, it may be helpful to start by asking a patient how his or her own expectations have been changing over the years. And/or you might take a few moments to discuss a handout you prepare for your patients that is similar to the following table.
Patient Role
| OLD |
NEW |
- Defer to provider’s authority
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- Share responsibility for own health
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- Be passive. Be “fixed” by provider
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- Be active. Self-manage health & condition (Provider supplies expert coaching, support, and sometimes direction)
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- Share history, when asked
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- Share goals, history, values, beliefs and preferences; If necessary, be assertive
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|
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- Decide what to do with support from provider
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- Rely on provider to solve problems
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- Seek provider support for solving problems
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- Learn about condition from provider
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- Learn from provider; inform self, too. Scan environment for new information
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- Respond to provider questions about progress during clinical encounters
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- Keep Track of own progress between visits; share during visits.
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- Don’t worry about medications (it’s all in the medicine cabinet)
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- Share responsibility for keeping medication list up to date
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Whether or not you develop your own version of a table like this, the idea is to work in a gentle yet steady way to change counter-productive patient expectations, while encouraging responsibility and initiative. You probably employ many simple techniques already, such as sending pre-appointment reminders to patients asking them to bring their questions and possibly their meds to the next clinical encounter, giving them a copy of clinical guidelines for their condition, and taking care to identify their main concern at the beginning of each visit.
Clarifying expectations, and encouraging responsibility and initiative are not things that can be discussed once and checked off. They need to be emphasized in a variety of explicit and implicit ways, and ultimately, woven into the fabric of one’s practice.
The “How-To Scenarios” to the right offer two examples of the kinds of relatively brief conversations that can serve to emphasize the growing importance of the patient’s role in a straightforward way.