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Patient Decision-Making

By Hiroyuki Hashizume, MD

Patient communication is one of the most important parts of surgery as well as diagnosis and treatment. My best tip for good communication with patients is ultimately about providing the best medical care. You need to be close to the patient’s story and understand his or her suffering. Furthermore, we should consider different perspectives regarding treatment benefits and disadvantages for each patient, the complicated effects of the patient’s surroundings, and that the situation is always changing. However, there is a ‘turning point’ to decision-making. The doctor should be prepared to assist a patient in making the decision to proceed with treatment for example, and it is the doctor’s responsibility to clearly explain the best path forward in good time.

To that purpose, it is necessary to organize the doctor’s own heart and mind.  Speak clearly and concisely everywhere and always to your patient. Achieve your goals by speaking what you mean. Such an attitude is important when interacting with patients and their families, as is maintaining an appropriate posture, smiling, heeding speech tone and speed, body language, and even walking style. Communicate clearly with sincere conviction.

Judgments are made according to scientific method, medical technology, and aesthetic sense. On occasion, there can be a conflict between the best interests of the patient, and limited resources available for his or her treatment. Focus such problems between the doctor and the patient, externalize, and switch from “persuasion” to “negotiation”.

Problems can also exist if opinions are opposed, and these should be finalized by the following medical examination. It is important to accept the existence of simple misunderstandings, differences in perceptions, differences in preferences, to find  mutual understanding, share concerns, and even to hold your patient’s hand if necessary. Consider deviations from outcome priorities and discuss outcomes and how you want to proceed with the patient.

In order to come to an agreement with patients without regrets, it is important to decide calmly, three-dimensionally, and with adequate forethought. I think the best tip is to be prepared to actively participate in the patient’s decision.

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