TECHNIQUES USED BY DOCTORS WHEN INFORMING PATIENTS

This information is made up of three components: 

The doctor’s answers to these questions will depend on what the patient knows and what he asks.

The most difficult of the three questions to answer is the second.

Indeed, explaining exactly what the problem is (the first question) may not be too difficult or painful. Explaining what can be done (the third question) is not difficult. On the contrary, this is the “constructive part” of the whole conversation, which gives rise to new hope and sets objectives. These explanations will, in turn, lead to other questions (“How, when and where do I have to do this therapy?” “Will it cause any side-effects?”); for many patients, these questions will take priority over the core of the problem, which is the second of the points listed above: “how serious is it?”.

The answer to the second question is undeniably very difficult.

The doctor must not rush this answer, trying to say everything straightaway. It is a mistake to do so. It is better to inform the patient step by step. One of the methods that the best doctors use in order to get onto the patient’s “wavelength” is to let the patient speak. The patient’s family members may well be surprised by this approach; they certainly do not imagine that the best way to inform the patient may be to begin by asking such questions as “Well, what have you been told so far?”… “What impression do you have of this problem?” or even more simply “What’s the problem?”.

These are vague questions, but they are very important and, in their simplicity, leave the patient plenty of space. In reality, the doctor is not yet informing the patient; rather, these questions allow him to understand how aware of the problem the patient is and, especially, how much the patient wants to know about the nature and gravity of the disease and what must be done.

Curiously enough, these questions, which may seem inexplicable or even shocking to the patient’s relatives, very often appear to be perfectly natural to the patient himself, so much so that the most frequent answers fit into a kind of standardized scheme. On the basis of the patient’s answers, the doctor can “adjust his aim” when deciding how and how completely to inform the patient. Some of the things that patients typically say are:

1. “You know, Doctor, no one has told me anything; all this mystery is making me think of the worst……..” Evidently, this patient needs clear answers. She wants things to be explained clearly, even if in stages, and if she does not get this clarity, she will want to know why.
2. “I really don’t know. You tell me. That’s what I’m here for”. This patient seems to be almost “annoyed” by the questions; he is very determined to find out how things are. His tone is almost sarcastic, as he is no longer prepared to listen to the umpteenth person who does not tell him what he wants to know. In such cases, the doctor must necessarily explain everything in full.
3. “I’ve been told I’ve got an inflammation of the lungs and I’ll have to have therapy, but I feel well. I don’t know why I was told to come and see you”. This situation can be clarified by asking the patient “What idea do you have? What do you think?”. The patient will then feel that he is at the center of attention, as indeed he should be, and will usually lay his cards on the table, allowing the doctor to understand how much he already knows and what he wants to know.
4. The patient does not answer; with a surprised expression, she turns to the relative who is with her and asks him to explain what he knows. Clearly, this patient does not want to hear a lot of explanations; she is one of those rare people who prefer to be helped by a relative, not only for what concerns the practical aspects, but also with regard to decisions and dealings with the doctors.