November 21, 2016
By Hina Mehta, MD
Last month Saint Louis University Hospital participated in Right Care Action Week for the first time. During this week, we intended to improve communication between patient and clinician by participating in a project called “What Worries You?” Our diligent medical students handed out blank note cards to patients to write down their biggest concern. We then discussed each patient’s concerns on rounds and how best to address them.
Initially, residents, including myself, were skeptical of this exercise. We thought this was another tedious and trivial task. We already had too much to do, and this was just another obstacle getting in the way of real medicine. However, we changed our minds pretty quickly.
On our general medicine service, we had two female patients present with abdominal pain and distention. Further workup found that both women had local colon adenocarcinoma, and they were going to be treated very similarly. Each woman expressed her greatest concern on her note card, and they were surprisingly alike. Both were apprehensive about their lack of knowledge of the diagnosis and what treatment options specifically existed for them. One patient sought any treatment possible, while the other patient desired to avoid invasive treatment to improve her quality of life.
No diagnosis should have a “one size fits all” treatment plan.
There is a tendency to overlook a patient and just treat a diagnosis in medicine. In school, we were taught to listen to a patient to determine the coveted diagnosis. In real life, the hard part is not just determining the diagnosis, but also identifying the appropriate treatment plan with consideration of a patient’s values and concerns. Every treatment has a profile of risks and benefits that will affect each patient differently. With so many emerging treatment options, patients are relying more on physicians for guidance.
It is a physician’s responsibility to determine a patient’s preference diagnosis by learning his or her values and expectations. In the article, Stop the Silent Misdiagnosis: Patients’ Preferences Matter, the authors stress the importance of preference diagnosis or the “inference of what a patient would choose if he or she was a fully informed decision maker.” Physicians run the risk of recommending inappropriate treatments for patients if they do not account for these concerns or preferences. But this often goes underreported. Evidence also shows that patients more engaged in their decision-making choose less intensive care, which would likely reduce health care costs and unnecessary treatments.
The simple note card created more obstacles for me, but they were necessary. These notecards highlighted the patients’ worries and their lack of knowledge regarding their conditions.
I now form a mental note card with each patient to encourage them to become more engaged in decision-making.
Hina Mehta, MD, is an internal medicine resident.