Helen Salisbury: The value of curiosity

One of the most inspiring teachers I met while studying to be a GP was a gentle man with a bright light in his eyes and excitement bubbling beneath the surface of almost every expression. He did not impress with great diagnostic skills (although I have no doubt he had them) nor with a thorough grasp of the latest clinical guidelines (which were mercifully few in those days). What stood out was his endless interest in his patients. He was fascinated and intrigued—not only by their illnesses but also by their lives, and he clearly believed that by understanding their thoughts and motivations, he could do a better job of helping them improve their health.

Some of what we do as doctors can continue on a superficial business level, including the many temporary problems we encounter: yeast infections; infected, ingrown toenails; sprained ankles; even acute appendicitis. With these we can advise, treat, refer and if we are lucky, solve the problem quickly. But many other health problems we see every day are complex and persistent, such as diabetes, high blood pressure, cancer or depression. In these cases, how the patient thinks about his illness and what he understands about the purpose and structure of the treatment will play a role in whether he decides to take the course recommended by the doctor.

Their decision also depends on many other factors—money to pay for prescriptions, how much their symptoms bother them, and their trust in their doctor—but any treatment plan must make sense to the patient. How many patients each year take their first pack of blood pressure pills but don’t ask for more, simply because they assume the problem is now cured? Explanations only work if they start with what the patient already knows: if I have some understanding of the mental model my patients are working with, my suggestions are more likely to be accepted. Of course, this needs to be done with care, as any attempt to get into my patients’ heads could come across as intrusive or just plain weird.

Much has been written about examining patient priorities—often including the suggestion that we ask unanswerable questions such as “What matters to you?” But whatever we ask, we need to convey a genuine interest in the patient as a person with a rich life of his own, into which our medicines must somehow fit.

We need to be more skilled and practiced in exploring patients’ perspectives and working with them so that we can unite around the goal and our treatments will be acceptable and effective. This takes time and is hugely helped by continuity of care, but although we need 4200 GPs and some of my colleagues report up to 90 clinical contacts a day,12 we will struggle to live up to my bright ideals. former instructor.

Leave a Comment

Your email address will not be published. Required fields are marked *