What Melanoma Taught Me About Patient-Provider Relationships
Key lessons in shared decision making
Posted Aug 30, 2016
As a medical professional, it’s an eye-opening experience to step into the role of patient. Recently, I was diagnosed with acral lentiginous melanoma, and the experience has reaffirmed my belief in building positive patient-provider relationships based on trust and continuous communication. When I was diagnosed, I sought out two different providers for potential treatment plans. The first provider was extremely accommodating; he was willing to engage in dialogue and to hear out my questions and concerns. More importantly, the physician took the time to learn about my personality, career and lifestyle and include me in the process of developing a treatment plan. I often lecture on shared decision making, and it was great to see what I communicated to providers put into practice.
However, in any major medical decision, it’s important to acquire a second opinion.
Unfortunately, the second provider wasn’t concerned with establishing a relationship, and he was, at times, standoffish and impatient. This physician not only disagreed with the initial melanoma diagnosis—he didn’t believe me at all. He informed me that the mole had to be removed immediately, and I could be in and out of surgery in a single day. The doctor failed to offer me any treatment options or incorporate my lifestyle choices into the diagnosis and, from a provider standpoint, the experience was impersonal and unprofessional—similar to standing in a long line at Costco.
I returned to the first provider and worked with the team to develop a treatment plan that accounted for my medical concerns and lifestyle choices. The surgery was more intensive and complicated than the “in-and-out” procedure that the second provider had predicted and, without the thorough treatment plan created by my health care team, the recovery would have been far more intensive and tedious. This experience further cements the need for providers to include patients in the shared decision-making process. Patient-provider communication must be a priority, and patients need to have input regarding their course of treatment in order to have an optimal health care experience. Here are some ways to improve patient-provider communication.
Improving Patient Care with Communication
Most physicians, on average, spend roughly 13 to 16 minutes with a patient during an appointment. Financial pressures and overloaded schedules are often the primary reasons why physicians keep appointments brief and to the point, but in doing so, physicians often miss out on the opportunity to establish a rapport with the patient, failing to learn more about the patient’s lifestyle choices and medical needs. These impersonal appointments can result in poor medication adherence due to unanswered questions or unaddressed concerns, and they also encourage a general lack of trust.
For example, roughly 50 percent of patients with chronic illnesses don’t take their medications as prescribed. Only 58 percent of American adults believe that doctors in the U.S. can be trusted; while in comparison, 76 percent of British adults and 79 percent of adults in Denmark believe that doctors in their respective nations can be trusted. In order to improve trust and boost medication adherence, providers need to understand their patients. They need to familiarize themselves with the patient’s lifestyle choices and mindset to create optimal treatment plans. Simply put, doctors need to engage patients. Some doctors may not be able to stretch their in-appointment times past the 15-minute mark, but technology—such as medical portals or remote appointments via webcams—might help providers gain a better understanding of their patients’ needs.
Understanding Patient Values
Simply encouraging physicians to communicate with patients will not improve the patient-provider relationship alone. Providers also need to come to terms with their patients’ values and create an environment that promotes shared-decision making, which is defined by Neil Greene in a blog on The Substance Abuse and Mental Health Services Administration (SAMHSA) website as “an approach where clinicians and patients share the best available evidence when faced with the task of making decisions, and where patients are supported to consider options in order to achieve informed preferences.” When patients are dealing with complex medical decisions, it’s essential for providers to offer evidence-based treatment options while considering the patient as an individual and including them in the treatment plan.
Sometimes, the patient makes a difficult choice, but they stay true to their personal philosophy after weighing all treatment options. For example, Bob Marley was diagnosed with acral lentiginous melanoma, the same cancer with which I was diagnosed, in the late 70s. The cancer was in his right toe, and doctors encouraged Marley to have the toe amputated. Marley refused, citing religious reasons. The cancer would eventually spread to his lungs and brain, claiming his life.
It’s possible that with an immediate amputation, the cancer’s spread may have been halted. However, looking to Marley’s example, it’s important for providers to take their patients’ lifestyles and spiritual beliefs into account when crafting a treatment plan. By doing so, it’s possible for the provider to curate an approach that satisfies all needs and properly address medical concerns, while also ensuring the patient’s overall mental, physical and spiritual wellness. By communicating with the patient effectively and building up a sense of mutual respect and empathy, a provider can avoid detrimental medical dead-ends where patients, who fear not having a say in their treatments, steer clear of medical assistance altogether in order to protect their personal beliefs.
Patients, as I learned firsthand, have to speak up about their concerns and share in the decision making, and providers have to be willing to listen. Providers must take the time to be with their patients in order to understand their needs, and if they can’t physically spend more time with patients, then they should explore new technological options or other strategies to help facilitate the communication process and deliver quality care. By engaging with patients, providers can not only craft more effective treatment plans that will effectively meet patients’ mental and medical needs, but also help to restore trust in the medical community. Creating a patient-centered culture with an emphasis on shared decision making is an important step in revitalizing the nation’s healthcare system.
To learn more about Dr. Boring-Bray and her research, visit the Cummings Institute.