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Do you mind if I don’t take your advice?

Your customers, clients or patients are free to choose. Despite your most earnest desire to save them from themselves they may choose to pass on your advice today. Is that alright? They may decide never to give up on the donuts, to stop smoking or head to the gym. As a consequence they may continue on the way to chronic illness. Do people have responsibilities from the ethics point of view?

Autonomous patients do have duties most of which are left out of mainstream medical ethics. Some of these duties flow from the obligations all persons have to each other; others are the
responsibilities citizens have in a welfare state. More specifically, patients have duties corresponding to those that render doctors captive helpers. Patients have to- morally have to do their best to ensure that they minimise this captivity and enable doctors to be willing helpers. Although doctors remain captive in the face of acute or life-threatening illness, it is not unethical for doctors to free themselves from this captivity in cases that fall short of life or death. Draper and Sorell

Picture by Viv Lynch

Do you advise or dictate?

What do you advise most people who seek your help? What will solve most of their problems? It was interesting to read an article this week suggesting that junk food may be associated with depression. In her commentary Megan Lee notes:

Depression has long been treated with medication and talking therapies – and they’re not going anywhere just yet. But we’re beginning to understand that increasing how much exercise we get and switching to a healthy diet can also play an important role in treating – and even preventing – depression.

For many of the most coveted outcomes in healthcare three things are paramount:

  1. Eat less
  2. Exercise more
  3. Don’t smoke

Simple focus. Not easily translated in practice because selling a healthy lifestyle is tricky:

Interviews with 130 mothers of lower social class provided the basis for studying their views on the desirability of general practitioner intervention in their lifestyle habits; the study used both quantitative (questionnaire) and qualitative (interview) techniques. The majority of women were in favour of counselling on specific topics by the general practitioner but the qualitative data also revealed that most respondents expected the issues to be relevant to their presenting problem. Moreover they were keen to assert their right to accept or reject the advice given. Stott and Pill

Picture by Fit Approach

Who leads the way down the corridor?

It may seem a tiny detail but as you walk your client, customer or patient through your clinic, shop or premises who walks ahead? Specifically when you get to where you both need to be who takes the first step into the room? Does it matter? Have you tried to do it differently? What does your guest think? How do you know? Could it be part of the ritual of welcoming someone to your office? Here’s a perspective from Workopolis:

Hold the door. When you go through a door, always look behind you and see if anyone else is coming. If someone is, hold the door open for them for Pete’s sake. The same goes for when you are getting into the elevator and you see someone coming. Hold the elevator. It’s what separates us from the animals.

Picture by Carol Van Canon

What do you share about yourself that’s a safe topic?

Health warning:

As a doctor, the reality is you are never off duty and their status in the public eye demands a high standard of conduct at all times. Dr Naeem Nazem 

At some point someone will ask you where you went on holiday or why you have a model airplane on your shelf. You can choose to be very ‘private’ or have something you might find increases the connection with that person without befriending them on Facebook.

Physicians aged 40 to 59 years report that they most enjoy running or jogging (36%), bicycling (35%) and camping or hiking (24%). About 50% of physicians older than 60 years reported walking to stay healthy.  Other interests include golf, aerobics and cardio, skiing, tennis and fishing. Other leisure activities reported include reading, with many physicians describing themselves as avid readers; regular reading was reported by more than half of physicians under 40 years, 58% of those aged 40 to 59 years and more than 64% of those aged 60 years and older. Endocrinology advisor

The trick is not raising topics that should be off limits but it makes you more human if your client, customer or patient knows you are an avid reader, you play golf or sing in the choir. You can prompt the chat by having a prop for something that you are happy to share. My doctor has a picture of a civet cat in his room. I’d love to know why,  he tells me everyone asks him about the cat.

Picture by  Daniel Colovini  

Do you perform any rituals during your day?

Do you perform any rituals during your day? Why? What is the value of the ritual?

Despite the absence of a direct causal connection between the ritual and the desired outcome, performing rituals with the intention of producing a certain result appears to be sufficient for that result to come true. Francesca Gino, Michael I. Norton

Picture by Sulen Lee

Are you ready yet?

What do you do before you interact with your next customer, client or patient?

Gaze and body orientation communicate levels of engagement with and disengagement from courses of action. As doctors and patients accomplish regular tasks preparatory to dealing with patients’ chief complaints, doctors use gaze and body orientation to communicate that they are preparing but are not yet ready to deal with those complaints. In response, patients wait for their doctors to solicit their chief complaint. These findings have implications for research on nonverbal communication, interactional asymmetry, and power.

JD Robinson

Picture by Mad African

What problem can’t you solve?

Armed with a hammer everything looks like a nail- except it isn’t. We need to be clear what healthcare is for. Doctors cannot ‘cure’:

  • Debt
  • Workplace bullying
  • Violence
  • Illiteracy
  • Homelessness

In addition there are many other problems that may be beyond curative intervention and a few others that require people to make different choices more than the doctor to prescribe something.

The unbridled enthusiasm for guidelines, and the unrealistic expectations about what they will accomplish, frequently betrays inexperience and unfamiliarity with their limitations and potential hazards. Naive consumers of guidelines accept official recommendations on face value, especially when they carry the imprimatur of prominent professional groups or government bodies.

Woolfe et al BMJ

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Are you sure they can help?

One of the key roles in healthcare is to refer people to other sources of help. The list of therapists, specialists and clinics is as long as any phone directory. However off loading someone elsewhere is hardly worthwhile if it’s a waste of time and money.

The goal should always be the initiation of a discussion about a patient’s needs and the beginning of a triaging process to address these, rather than problem identification being an end‐goal itself. Gemma Skaczkowski

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What do they know about you?

Whenever someone new visits your shop, cafe or clinic for the first time they make a decision to give you a chance. It’s worth asking what persuaded them to do that. What’s their perspective on your business? Which of your previous patrons do they know? What do they expect? Can you deliver? They are telling you something merely by their presence on site.

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How do you explain?

In any meeting where you are the expert how do you explain technical details? As a doctor how do you explain viral illness? Warts? Heart disease? Cancer? How do you know the other person ‘gets it’? Do you say the same thing every time? Do you use pictures? Sounds? Have you practiced the script as much as you practice other aspects of your art? Why or why not?

Andrew McDonald wrote in the BMJ:

The development of such a language, securely founded in shared meanings, would be a good first step towards better communication between professionals and patients. It would not, of course, deliver the goal of full participation in decision making, but that goal will remain elusive unless we begin by understanding one another.

Picture by Marco Verch