In the medical model, healthcare providers are often treated as technicians. Patients ignore their bodies until they break down, then bring them in and say, “Fix this.” As a result, care is episodic and driven by acute patient problems.  In chronic conditions, this model leads to poor patient outcomes, provider frustration, and waste of resources.

Self-management cannot be episodic. Patients must do it every day. Self-management support aims for consistent care based on strong respectful relationships among patients, families, and health care providers. These relationships can grow over time. Providers and patients can learn to make them stronger.

What Kind of Relationships?

Research has demonstrated that patients want their clinicians to know them as whole persons, with fears, hopes and dreams, families, jobs and social roles. People with chronic conditions want to be seen, heard, understood and respected. A large majority of patients want to be offered options for treatment and self-management, and most want to actively participate in decision-making and goal setting. Patients who report that their clinicians know them as people, who experience trust, empathy and respect, and who are provided with choices and options are more likely to participate actively in treatment and self-management and, as a result, experience improved outcomes.

Above all, it comes down to the degree of mutual trust that is able to be developed. Patients can form relationships with others on the provider team, not only with clinicians. The following specific communication skills can help clinicians and other team members build effective collaborative relationships with patients and families:

Ask open-ended questions – invite the patient to share their “story,” not just about immediate health problems. E.g. “What is most important to you now?”  “Tell me about…”
Use reflective listening – seek to understand the meaning of the story. (See Collaborative Goal Setting)
Express empathy – seek to comprehend the patient’s perspective

• Respond to and reflect feelings, concerns, beliefs, values - “You are quite frustrated and upset about...”
• Normalize – “Many people experience…”
• Affirm – “You have been doing what you can…”
• Self-disclose (when appropriate).

Regular follow-up strengthens patient/provider relationships.  Follow-up schedules and means should be worked out with the patient. (See Follow-up page)