Unfortunately, over the past few months I have had occasion to visit many friends and family members both in Intensive-Care Units in hospitals and at home recuperating from their medical intervention. While my experience recently has been in Spain, I have observed exactly the same behaviour is many other countries.
It appears that many patients in hospital often become much less Auditive (focussed on data such as clinical results, etc.) which makes it much more difficult to process on the cognitive logical level – for them!.
While Doctors tend to try and avoid “Emotional empathy” (suffering the same “distress” as the patient) and maintain an attitude of “Logical empathy” (where they understand the patient’s situation, fears, hopes, etc) but are NOT affected. This apparent lack of any empathy with/for the patient often works against them with both with the patient and the family members, etc., where they are perceived as “Cold, Distant &/or uncaring / heartless” Realistically, Doctors have to have “logical” empathy or it would often be impossible to provide the care or treatment the patient actually needs however, this perception of the Doctor can have unexpected NEGATIVE consequences – especially if things go wrong!
Doctors, in general, tend to work on data from a range of different sources and frequently tend to provide information in the form of percentages or other “logical” forms;
An example of this would be: “There is an 80% possibility of success (without defining “success”) and 20% possibility of death or deterioration”. This option is often perceived as being much worse by the patient because they appear to only be considered as part of a statistical group and NOT as an individual person whose fate / life is in the balance. Also, the sequence of the options provided is a way to influence, on a subconscious level, how the information is mentally processed. Thebest technique to use is called “The Double Bind” and states that when 2 options are given, the last option is usually chosen/remembered WHEN there is NO specific preference for either of the two “options” given.
From my own personal experience and from many ex-patients that I have spoken to regarding this topic, it appears that most people would often prefer a more open and non-specific range to be given: “A high possibility of X and a lower possibility of Y”. This kinaesthetic version allows the person to create their own mental ratios of the options presented based on how they feel physically and mentally. However, if the patient then asks for the specific odds for each event, they should be given – with the “good news” being given after the bad!
I beliee that it is the duty of every doctor to use the most appropriate persuasive strategies to help the patiends and/or family members to make the “best” decisions possible. This includes a sensitivity to the language and structures used to achieve the desired outcome.
I hope this article has provided some interesting ideas for you.
All constructive feedback would be appreciated.
Ian Brownlee
Madrid, Spain, 21st March, 2019.
Sources:
W.Levinson, A. Kao, A. Kuby, R. A. Thisted: Not All Patients Want to Participate in Decision Making – A National Study of Public Preferences
Strull WM, Lo B, Charles B. Do patients want to participate in medical decision-making? JAMA. 1984;252: 2990–4.
Guadagnoli E, Ward P. Patient participation in decision-making. Soc Sci Med. 1998;47: 329–39.
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