Takeaway
Some patients have strong preferences that may not align with best practices of care. Empathy, active listening, and kindness can build trust and guide patients toward making informed medical decisions.
Connecting with Patients | July 17, 2024 | 1 min read
By Anh Tran, MD PhD, Vietnam and Amy Yu, MD, Johns Hopkins Medicine
Dr. Y stood outside the room, steeling herself for the encounter ahead. Her patient, Mrs. W, an older woman with extensive metastatic cancer, had a massive sacral wound that exposed her internal organs. Despite the gravity of her condition, Mrs. W had repeatedly refused to discuss goals of care, clinging to the hope of a miracle. Her capacity fluctuated, and family tensions over care decisions made these conversations even more challenging.
Building bridges
Dr. Y paused and took a deep breath, preparing to step into a person’s life story. “How are you feeling today?” Dr. Y asked gently as she entered. “Did you sleep well last night?”
The patient’s eyes, filled with a mix of pain and weariness, met the doctor’s. A connection formed in that simple moment of genuine inquiry.
Mrs. W declined a wound examination. Instead of pushing, Dr. Y listened as she expressed a strong desire to go home. “I understand wanting to go home,” Dr. Y acknowledged, her voice soft but clear. “But I have some concerns about your wound care. It’s quite serious. Even someone who loves you dearly might not have the specialized training needed. If this happened to my mom, I couldn’t take care of it at home.” A thoughtful silence followed. It wasn’t resistance; it was recognition.
Shared decision-making: respecting autonomy
“Perhaps a skilled nursing facility could be a good option,” Dr. Y suggested. “They have trained professionals who can manage your wound. Would you like to see pictures of it yourself?”
Although Mrs. W declined, this offer of sharing knowledge empowered the patient to participate in making the best decision. Mrs. W said that although a nursing facility wasn’t her first choice, she understood that it was the best option. Dr. Y’s patient approach, coupled with clear explanations and respect for patient autonomy, resonated. The decision for a skilled nursing facility wasn’t forced; it was a collaborative choice, fueled by trust and focused on the patient’s well-being. By persistently approaching the situation with empathy, respect, and shared decision-making, Dr. Y helped Mrs. W make a decision aligned with her values.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.