It’s interesting how clearly body language communicates our response to what someone is saying or to a situation.
Dee Dee – Although it wasn’t communicated verbally, I knew the news about my diagnosis wasn’t what I wanted to hear. The doctor came into my room after my colonoscopy exam and stood at the foot of my bed with his head drooped down. His body language said it all. The doctor and I had hit it off from the first moment I met him. Those who know me can tell you that I love people and make friends very easily. So no … it wasn’t strange that I would make a friend in my proctologist believe it or not. To make delivering the bad news easier on him, I said to the doctor, I have cancer don’t I? He was still looking down and shook his head yes. I immediately cried, no sobbed uncontrollably. He continued to talk, but I don’t remember one word he said. Just about everything was racing through my mind at the time. I thought I would die. My children… how would they handle the news? Finally, I thought I heard a voice saying wait listen to what I’m saying … it was the doctor saying it’s not over its operable. I finally stopped sobbing and started to listen.
Stephanie – I watched a video this week on the topic of Minimally Disruptive Medicine by Victor Montori, M.D., Mayo Clinic http://youtu.be/flcRKdoaiVk. In his presentation, he spoke about the importance of doctor’s picking up on queues that patients give with their body language. Doctor’s often become frustrated when patients don’t comply with their medical advice and/or fail to follow prescription guidelines and or referrals to specialists. Lack of compliance is usually not a result of laziness or lack of esteem for their professional opinion. The truth is that patients often face a number of external disturbances that affect their ability to follow instructions from their doctor. The disruption in the treatment plan can relate to domestic roles, financial burdens, inability to take that much time off of work, and/or limited literacy on how much (what dosage) and how frequent (what time and how often) they are meant to take their prescription during the day.
Dr. Montori’s presentation using a fabricated patient’s case was very astute. In his message, domestic responsibilities (his family was depending on him to carry the load) were the cause of non-compliance. You see his daughter had recently experienced a loss and moved in with him and his wife bringing her three kids along. He had an obligation to work and carry the financial burden. In order for him to comply with the doctor’s orders a number of things would need to occur. He would need to get a ride to a dietician, take off of work, see an endocrinologist about his obesity and high cholesterol, he needs to avoid salt, fats, carbs, he needs to take and manage prescriptions for diabetes and hypertension which make him dizzy and depressed. He needs to ask his wife to check the condition of his feet because he’s obese and can’t see them properly. He also needs to check his sugar. He has lower back pain, neuropathy and should be evaluated by a podiatrist. Treating these symptoms means more time off work and the patient couldn’t afford to do this. He is in pain all the time and he can’t sleep. His work load is increasing. He has deadlines at work and has to take work home to perform and keep his numbers up. He’s worried about his company going under. If his company fails, he will lose his insurance and likely go into debt. If he’s not able to pay his mortgage, he’ll eventually lose his home. Unfortunately, the program the doctor has prescribed doesn’t FIT into the context of all that is going on in this patient’s life.
When the patient finally returns to see the doctor, non-compliance is interpreted as failure, laziness or non-cooperation. The doctor does not recognize all of the surrounding circumstances, but identifies the breakdown as a lack of effort on the patient’s behalf.
Dr. Montori’s suggestion to adopt a more realistic treatment plan to fit the patient’s lifestyle. Instead, the doctor typically intensifies the treatment regimen when faced with non-compliance – adamantly insisting the patient needs more treatment. As you know, this leaves us, the patient, shifting towards self-management of our care. As patient’s we often frequently go to other patients to ask for help. After all, they can relate to our point of view and share what’s worked or hasn’t from their own perspective. Dr. Montori suggests ‘minimally disruptive medicine’ as a needed change for the future care coordination. By measuring key areas that help focus to turning towards the goals that matter : burden of the treatment; coordination of care; comorbidity (presence of one or more disorders/disease) in clinical evidence and guidelines; and prioritizing from the patient’s perspective.
I will watch with great interest and hope more doctors will adapt to treating patients using Minimally Disruptive Medicine.