The Participating Patient

Patients are more likely to accept recommendations from the physician if they feel they are a part of the process of treatment. Physicians often have different agendas than do patients for the clinic visit. The physician wants to find the problem, identify it, and bring hope and healing to the person. The patient wants to tell a story, to help better understand the illness, as well as find healing and recovery.

The patient can be encouraged to tell the story, even within the time constraints of the visit, with a statement such as, "We have about 15 minutes together today. How do you want to use this time? What do you want me to know?" In this way, the physician structures the time for the patient, and also gives the patient the freedom to express what he or she thinks is important. As the diagnosis and recommendations are made, the physician may ask the patient a question such as, "How do you want to participate in your treatment?" As Stone and colleagues (1998) observe, the physician is encouraging adherence rather than insisting on compliance: "Compliance implies an involuntary act of submission to authority, whereas adherence refers to a voluntary act of subscribing to a point of view."

Pearl

"Communicating your understanding of the patient's experience of the illness is one of the most therapeutic techniques we can use. The more I listen, the more my patients understand'" (Platt and Gordon, 2004).

Pitfall

Be careful not to lose the human being in the discussion of the disease entity. Avoid identifying the patient by the disease rather than by a personal description, such as the woman, man, boy, or girl who has the disease; the people are not the disease.

Pearl

The person is not the problem. The problem is the problem.

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