Doctors interested in empowering their patients to speak freely could begin by handing them this workbook.
As we were working on the materials for this website, my attention was called to a new study in Health Affairs that suggested even the most affluent, educated patients felt reluctant to ask questions or speak up about treatment preferences.
The study has been archived now, but its message has stayed with me. The patients studied said they felt their doctors were “authoritarian” in manner. The study’s authors contend, “physicians may not be aware of the need to create a safe environment for open communication to facilitate shared decision-making.”
As an eyewitness to the medical encounter I observed that many doctors may well be aware of the need, but unsure of just how to create that safe environment. Particularly when “cure” is not an option. And as a result, they may be disheartened or avoid the conversation because of how little they feel they have to offer their patients.
The Health Affairs study worried about the ongoing lack of progress when it came to teaching doctors to invite patients to speak up. One participant’s comment was strikingly familiar: “I don’t know if the reason why I was so poorly informed was because I don’t ask enough questions or because they don’t give me enough information. It seems to me everybody is in a hurry…and I begin to feel guilty about taking up their time and…after it’s all over I…think to myself, why didn’t I ask them more questions?”
And yet reading this, I felt hopeful. Because the very website we were designing was conceived as a way of helping doctors begin exactly this dialogue. Which means that, for doctors, creating that “safe environment for open communication” could be as simple as handing the Difficult Conversations Workbook to a patient and saying:
“As you go through this workbook, know that I am here ready to listen and address your questions and concerns. There might be hard choices to make—but we’ll do the best we can together.”
And just like that, a real conversation will have started.
–Celia Engel Bandman