Many people see physicians as experts in “the science” of medicine. In my three decades of practising as a family physician, I have learned that being an expert in “the art” of medicine is of equal importance. Underlying this art is the therapeutic and caring relationships that we build with our patients.
I am there for patients during the big moments in life — births, illnesses and deaths — and the not-so-big moments, when someone has a concern and needs some reassurance or has a question about what is best for their health. The way that I have built and strengthened these important relationships with my patients over the years is through a good conversation.
When I see patients, I try to understand what underlies their concerns, and how I can provide reassurance. And reassurance doesn’t always come from ordering a test or treatment.
In fact, sometimes a test or treatment may not be needed and can lead to harm.
For example, guidelines have changed and we do not offer an annual Pap smear for women. Instead, certain age groups are screened every three years, and others not at all. Same goes for ECGs(electrocardiograms). This test isn’t useful in routine checkups for people without heart disease risk factors or family history. In fact, an ECG can sometimes show commonly found and harmless abnormalities, leading to undue anxiety, further testing and treatments.
I always encourage my patients to come in for an annual health visit to discuss questions or concerns.
Even when there are specific health concerns, a test may not be the right course of action. For example, a common complaint we see in family medicine is lower back pain. Many patients want an X-ray or MRI. But large studies have shown that patients who undergo imaging do not fare any better than those who don’t. Imaging can reveal spinal abnormalities completely unrelated to the pain. This may cause worry and may lead to unnecessary followup tests and procedures such as injections or sometimes even surgery.
It is human nature to want a quick fix, but sometimes evidence shows this isn’t the best way forward.
The overuse of antibiotics is another good example. Family doctors see a lot of parents bringing in their kids complaining of painful ear infections. Most ear infections are caused by viruses, not bacteria. But ‘just in case’ it has become habit to prescribe antibiotics, which are only effective against bacteria. This doesn’t help our patients, and in fact, pain-relieving, over-the-counter medications can better ease the child’s pain.
Antibiotic misuse harms us all and studies show it has led to the spread of powerful, antibiotic resistant superbugs.
In these situations, where doing a test or treatment can cause more harm than good, I try to reassure my patients through a good conversation.
There’s a big body of evidence behind the power of communication. It turns out, good conversations between doctors and patients is good for patients’ health and well-being. When patients feel that their doctor has communicated well with them, they report a better understanding of their health problems and treatment plan.
Good communication also makes patients and their family members feel happier with the care they have received.
A study led by a group of Canadian researchers from Ottawa found that when doctors and patients used decision aids to help foster conversations in areas of clinical uncertainty, patients feel less conflict and uncertainty and more confidence about difficult medical choices.
Another study surveyed family doctors across the U.S. about what the barriers are to reducing unnecessary care in their own practices. The doctors pointed to a lack of time during the clinical encounter to have a good conversation.
But patients have a right to ask critical questions about necessary and unnecessary care options that can open the door to a healthy conversation. That’s why Choosing Wisely Canada put together some ways to start the conversation between patients and doctors.
So whenever you are offered a test or a treatment ask:
• Do I really need this test, treatment or procedure?
• What are the downsides?
• Are there simpler, safer options?
• What happens if I do nothing?
A good conversation with your health provider shouldn’t be overly time-consuming for either of you. Both doctors and patients want to make best use of the precious moments in a clinical conversation. Asking these questions is a good way to start.
Dr. Lynn Wilson is an expert adviser with EvidenceNetwork.ca, a family physician at Women’s College Hospital and vice-dean at the Faculty of Medicine, University of Toronto.