Are You a Fixer or a Facilitator?
I grew up watching the medical show, Marcus Welby, MD, with a wonderful old “father figure” family doc at the heart of the series. Those were the good old days when doctors told their patients what to do, the patient went home and did what they were told, and, at least on TV, they got better. Patients came to expect that they could see their doctor and “get fixed” and as doctors we were trained to expect the same thing. It turns out that this old, paternalistic view of the doctor-patient relationship isn’t good for any of us.
There are many studies that show your patient’s health will benefit when they are more involved in their own medical care. This means that your role is not to fix them, but instead to act as a facilitator, enabling each person to take an active role as a participant in their own healing. What does it mean to have your patients more involved?
First, decisions are made as a partnership, allowing time in the visit for you to review all the issues around a medical decision or treatment plan. Our job is to have patience and to facilitate a discussion that will allow your patient to choose their own treatment. In my practice I certainly offer my recommendations, but ultimately what they want to do is what matters. And it turns out studies show that people who believe their treatment will help them, do better. Whether this is a ‘placebo’ effect or not is irrelevant. If your patient is engaged and agrees with their program, they are likely to have a better outcome.
Second, having your patients more involved means they need to step up and take responsibility for their lifestyle choices. Lifestyle behavior is at the root of all chronic disease, and this is not something that we can fix for people. Instead we need to be the facilitators to help our patients change their diet, learn relaxation techniques, exercise, and eliminate toxins like alcohol and cigarettes. Improving lifestyle behavior will have a huge impact on whether they will get better, and no pill that we prescribe can fix this. But this is their work, and to be successful, your patients must take more responsibility and become more involved in their treatment, a term called self-care.
As a doctor, you already know how hard it is for you to make these changes, let alone your patients. How can you help people accept self-care as central to their program and embrace their role in their own healing? First, you need to see it that way, and then you need to explain it to your patients that way. Next, you can offer a coaching attitude, giving them tools to succeed like nutrition counseling, classes, and written program guides. Studies have shown that people who practice self-care have better health outcomes—and it’s not just because these are healthy activities, but because of the sense of empowerment that they feel by becoming part of the solution, and getting involved in their own care and decision making. It turns out that the passivity of having someone “fix” you, isn’t good for you at all.
And for us, there is a huge advantage to this new kind of relationship. I love practicing medicine this way, and I think you will too. I enjoy having clear communication so that when we make a decision there is no second-guessing and we are all comfortable with the outcome. I know the importance of lifestyle changes for improving health, and knowing that I have a partner in my patient is energizing and positive for both of us. The outcome of our treatment program doesn’t all rest on me, so I feel less stressed. I also know the limitations of “pills” to actually “fix” anything, and am therefore more optimistic about the possibilities, and this positive energy is contagious. Working together this way creates trust and the likelihood of a clear understanding of our goals, which is a win-win for all of us.