How Can Patients and Providers See Eye to Eye?

Trevor Torres, Student, Patient, “Diabetes Evangelist”

I think part of it is a lack of understanding, potentially, of the experience of the other parties. So, as a patient, you sort of understand that doctors have a lot of things going on, or providers are very busy. And as a provider, you definitely understand the science behind having diabetes or whatever condition, and you kind of have an idea of what it feels like to be the other person, but you obviously aren’t them. So it’s trying to bridge the empathy gap and communicate effectively that can be one of the challenges.

Opening up dialogue, especially when you first meet a patient, and communicating with them — kind of like Maureen said in her keynote earlier [at the IHI National Forum] — just asking, “What Matters to You?” The kind of providers that have done that for me have been much more successful than the kind that have gone into, especially a first appointment, with sort of a prescription in their mind of “Alright, here’s what we are going to do for a patient with diabetes.”

If I can give an example, I am still looking for an endocrinologist at [University of] Michigan that kind of fits with me as far as treatment goes. I work with an endocrinologist for research, but that’s a separate thing. One endocrinologist who I met with didn’t allow me to talk about my goals as a patient or anything. [The endocrinologist] just kind of got my numbers and said, “Alright, I have your chart. Here’s what we are going to do with managing your diabetes in the future.” But there was never a, “Well, what are your goals for this appointment? What do you perceive as your challenges? And what do you perceive as areas of improvement?” So, [the doctor’s] recommendation was increase or change dosages, whereas I think if I had been given the opportunity to dictate how that appointment had gone, it would have been much more about “How can we change this sort of behavior and how can I make it more convenient for me to eat in this circumstance or check my blood sugar in this circumstance being a college student who’s much busier?”

There’s probably a lot that could be said from a psychological point of view as far as a first impression leading towards different types of communication, but I think — as someone who has only taken one psych class — I think it sets the tone for the way the treatment will progress, so the second visit is probably going to be much like the first visit, just because you tend to fall into a routine.

So, it’s important for a good working relationship to be established as quickly as possible and [for] a provider to demonstrate that [he or she is] willing to empathize with the patient and also for the patient to, if they do have specific goals in mind, to kind of go in and express what type of patient they are.