Understanding the patient in a consultation: Guest blogger Dr. Shalini Ratan

In a disease-centric approach of medical consultation, the patient comes in with a disease and returns with a diagnosis, while in a patient-centric approach, the patient is diagnosed for the disease and is also understood more as a person, at the end of the consultation.

It is documented that in a consultation, usually a hypothesis about the disease is made in the first 30 seconds. This supports closed clinical questions towards the patient to further strengthen the diagnosis made. This approach might exclude the broader picture.

The time taken for the first hypothesis, if delayed further, allows more information gathering from the patient. This additional information might be regarding the patient, rather than the disease per se.

“Listen to the patient because they are trying to tell you the diagnosis.” – William Osler.

The patient comes for a medical consultation because they perceive that there is a change in their health pattern. They have a set of feelings, fears and expectations regarding the change in their health. So it is advisable to watch the patient all the time they are talking. Use of perceptive faculties to hear what the patient is saying and to pick up “the message behind the message” helps to plan the best management schedule.

Verbal and non-verbal cues are also a source to gather information in relation to the Person behind the Patient. This could be through the tone of voice, facial expressions or actions of the patient.

For example, a house wife who keeps busy the whole day is suffering from anemia. She is unable to plan for a healthy lifestyle, and she visits a doctor. The doctor does the clinical assessment, and as usual, gives a prescription for anemia.

Now the major concern for the patient besides anemia was her inability to plan for a healthy lifestyle, which she was unable to convey well enough to the doctor. So even after taking the prescription, it is quite possible that she would not be able to comply with it effectively.

So the physician, rather than saying “Please take these medicines” could ask “Would you be able to take these medicines”? This open ended question would give more time to the patient to think and elaborate on her concerns. This would make the patient relate more as a partner explaining her illness.

According to a study published in BMJ (May 2000), only 4 of 35 patients voiced all of their agendas in the consultation.

So, in certain cases, giving space to the patient to share their social problems along with their medical history would give them...

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