How can doctors address patients’ expectations?

No one wants to be sick, especially when no one can tell them what is wrong. In the U.S., we live in a culture where we want instant results; we want easy answers for complex problems. However, in medicine, there are often no easy fixes. Adverse medical events happen, despite our best efforts. For example, a young child was recently diagnosed with Type 1 diabetes mellitus. While he and his family struggled for many months to get this under control, they eventually did. Then, a few months later he was diagnosed with leukemia. Why? No one can answer this because the two diseases are completely unrelated. Is it unfair that one child should have two dreadful diseases? Absolutely, but that doesn’t change the fact that it happens.

How can doctors address patients’ expectations?

With honesty. Patients need to know the truth, good or bad. If we feel they are expecting something unattainable, we must balance their hope with reality. When we fail to do this, we take away the patient’s ability to make informed choices about their healthcare.

Providing enough information. I often see patients come and tell me that the specialist didn’t explain anything to them. We must do a better job explaining exactly what we think is causing their symptoms and the treatment plans. How can patients know what to expect without this discussion?

Through compromise. If a patient is requesting a test that we think may be unreasonable, we should explain our reasoning. Maybe another test will give us the same results or maybe the patients should have the test done that they are asking for. We must listen to their reasoning before making hasty decisions.

By discussing options. Often, there may be more than one way to treat a given disease. We may know which one that we think is the best, but we should present all available options to the patient and let them make their own decisions. Yes, we need to make sure they understand all the options and potential outcomes. However, when we don’t give them all the options, we are making the decision for them.

Telling patients when their expectations are unrealistic. If something is not going to work, patients need to know that. Why give chemotherapy to a terminal cancer patient if we know it is only going to make a patient sick and do nothing to treat the cancer?

Direct patients to further resources. Patients may need to time to make their decisions. Give them good references where they can study it on their own time and not feel pressured to make a decision.

Not only do patients sometimes have unrealistic expectations, but doctors also do too. We expect our patients are going to to take the medications that we prescribe for them or do the tests we recommend. Maybe there is some reason that prevents them from doing this; perhaps, the pills cost too much, or they are afraid of the complications of a procedure. If we don’t listen to what our patients are experiencing, we will never be able to get a handle of our expectations. We must listen to what our patients have to tell us. We need to give our patients the opportunity to tell us what they feel and expect. And we must not be afraid to tell them the truth, even if it hurts.

Linda Girgis is a family physician who blogs at Dr. Linda.

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