Have you ever reassured patients about matters that seem straightforward to you?
Whether it’s how to take a medication or healthy diet advice, patients will often ask for support and guidance that might be second nature to healthcare professionals.
But this isn’t always the case.
If you’re a newly qualified healthcare professional, you’ll soon be getting used to patients having their own health opinions.
Patients can and have a right to challenge your advice, seek an alternative opinion, and just downright disagree with you.
But what happens if they choose to follow a risky or even dangerous approach to their health? You can’t force them to agree with you, despite having their best interests at heart.
It can be daunting to stand your ground as a professional and remain empathetic to your patient’s opinion. This is where good consultation skills come into play.
Consultation skills are an important asset to have in your professional arsenal. Constant practice is usually the best teacher but in my experience, it helps to have some stock questions ready in your mind.
So how do you open up a discussion with your patient about the risks versus benefits of treatment, and all without being pushy?
The Science of Risk Perception
‘Risk perception’ is made up of various factors that challenge and shape our judgement.
In general, there are two ways we see risk: cognitive (based on our knowledge) and emotional (based on the way we feel).
When clinicians make treatment decisions, we base this on clinical evidence, data, and treatment guidelines. We also use our expert intuition and experience to guide our decision-making process.
Empathy towards your patients is important, but it can be difficult to balance empathy while keeping a rational mind. We have to keep some boundaries with our emotions, and not let them affect our decision-making.
Note: emotions aren’t a bad way to make decisions, but they should not be the only factor.
Patients don’t necessarily have access to research and guidelines, which is why they come to you for help. Even a healthcare professional may seek advice as a patient themselves because they need an objective view to keep away from their emotional subjectivity.
We want the best for our patients, but at the same time, we want to make sure they are kept safe and healthy. So how do you relate this to your patient without forcing your views on them?
Consultation skills are usually the last thing on your list when you have so many clinical priorities in mind. So here are four questions I’ve formulated just for you!
I’ve done the tedious task of going through hours of patient risk perception research so you don’t have to. These questions can be used to start a discussion with your patient about risk, but remember to use your professional judgement when doing so:
1. “Do you have any concerns about the treatment?”
It seems like such an obvious thing to ask, right?
The benefit of keeping this question open-ended is that it helps your patient fill in the gaps—you might be surprised by how much they keep inside.
Remember to be sensitive and receptive as several personal factors can affect how your patient will view the risks of treatment, such as:
- Someone they know had a bad, or even fatal, experience with a treatment regimen.
- They’re overwhelmed with their new diagnosis, so all this new information is unfamiliar and concerning for them.
- They might not understand the condition they have and the medication required to get better.
Explore your patient’s specific concern(s) and remember the goal isn’t always to get them to agree to treatment, but to help them evaluate the benefits and risks and make an informed decision.
If they still seem reluctant, it’s worth probing further and asking “what makes you feel that way?”
Open-ended questions are great, but sometimes you need to get to the heart of the conversation faster.
2. “Are you aware that [side effect] is very rare, and may only happen in less than ten thousand people?”
Side effects are a huge concern for patients, and rightly so.
When the Oxford/AstraZeneca COVID-19 vaccine was first used in the general population in early 2021, reports of a rare type of blood clot were recorded and confirmed as a side effect of the vaccine.
Despite health authorities stating that the vaccine is safe to use and that this side effect is extremely rare, many people are still hesitant to accept this. That’s completely natural.
COVID-19 is a relatively new disease which means that research is ongoing and ever-changing. Even healthcare professionals are sometimes unsure of what steps to take next when new symptoms or viral variants arise.
It’s no surprise that the perceived dangers of both the virus and vaccine compound people’s feelings of uncertainty and lack of control. This will influence health behaviour.
As a healthcare professional, you’re trained to evaluate evidence. By presenting this evidence (as framed in the question) to patients, you’re establishing their trust and confidence in you.
Blending evidence with an empathetic approach allows you to build a strong rapport with your patient, enabling them to evaluate risk effectively.
3. “Do you think you have a good handle on your condition?”
Uncertainty can arise from not feeling in control of a situation.
In a study of type 2 diabetic patients in China, patients who felt they could control their condition on their own perceived a lower risk of any further health complications. They had confidence in their care which lowered any worry and concern about the future.
Health behaviour can be influenced by not only how you evaluate risk, but also how you evaluate your coping methods.
Some patients struggle to cope with caring for themselves. This could be for several reasons, such as:
- Lack of support at home
- Cognitive or memory issues that make them forget to take medication
- Mental health illness that decreases motivation for self-care
All these factors can make someone feel unsafe. It increases a sense of not being in control which can lead to feeling in danger, or at risk.
But your patient might not be aware of this. If they feel like they don’t have a good handle, it would be good to follow up with “How can we help you to feel more in control?”
4. “How likely do you think it is for you to develop [health condition]?”
Having empathy doesn’t mean we shy away from discussing real-world problems. It’s not always easy to talk about the reality of life-changing health conditions, but that’s our job.
Some patients believe completely in their body’s ability to fight off illness without accepting that sometimes, we all need help to be healthy.
Patients who show unrealistic optimism are less likely to engage with treatment because they perceive their risk of developing illness, for example diabetes, is extremely low.
Maybe they don’t have a family history of the disease, or they get plenty of exercise and have an impeccable diet, and yet the disease has evaded all their best defences.
You could call this type of behaviour ‘denial’, but perhaps your patient just needs a reality check dosed with encouragement to accept their diagnosis.
By addressing this question, you can lay the facts out in front of your patient and help them to evaluate their options to move forward.
Encourage Discussion—Autonomy Builds Trust
It’s easy to tell your patient point-blank to follow X, Y, and Z treatments, but humans are rarely ever that easy. To build a relationship with your patient, you need to encourage their involvement in their care.
Studies have shown that engaging with and intervening in risk perception can positively influence health behaviour. Employing productive consultation skills can change the course of a patient’s prognosis.
But what does this mean for you?
Whether you have a brief ten-minute consultation or a spare five minutes more (they’re a rarity, I know), it’s worth discussing this topic with your patients, especially those that are reluctant to start any treatment.
We live in a climate of mistrust and scepticism in experts and scientific research, so it can be frustrating when your advice isn’t listened to. But perhaps our patients feel the same way?
Preserving autonomy (the ability to make an informed decision) is essential for successful patient care. By showing our patients that we want them to be involved, their confidence and trust in us increases.
You can aim to be that port of call for patients where they know their experiences and concerns will be heard, and in turn, they will value your judgement and advice.
