Medicine a science and an art

GOOD CONVERSATION BETWEEN DOCTORS, PATIENTS HAS IMPORTANT ROLE TO PLAY GUEST COLUMN

Many people see physicians as experts in the science of medicine. In my three decades of practising as a family physician, I’ve learned that being an expert in the art of medicine is equally important. Underlying this art is the therapeutic and caring relationships we build with patients.

I’m there for patients during the big moments in life — births, illnesses and deaths — and the not so big moments, when someone has a concern and needs some reassurance or has a question about what’s best for their health. The way I’ve built and strengthened these important relationships with my patients over the years is through good conversation.

When I see patients, I try to understand what underlies their concerns and how I can provide reassurance. And reassurance doesn’t always come from ordering a test or treatment.

In fact, sometimes a test or treatment may not be needed and can lead to harm.

For example, guidelines have changed and we don’t offer annual Pap smears for women. Instead, certain age groups are screened every three years and others not at all. Same goes for ECGs (electrocardiograms). This test isn’t useful in routine checkups for people without heart disease risk factors or family history. In fact, an ECG sometimes show commonly found and harmless abnormalities, leading to undue anxiety, further testing and treatments.

I always encourage patients to come in for an annual health visit to discuss questions or concerns.

Even when there are specific health concerns, a test may not be the right course of action. For example, a common complaint we see in family medicine is lower back pain. Many patients want an X-ray or MRI. But large studies show that patients who undergo imaging don’t fare any better than those who don’t. Imaging can reveal spinal abnormalities completely unrelated to the pain. This may cause worry and lead to unnecessary follow-up tests and procedures, such as injections or sometimes even surgery.

It’s human nature to want a quick fix but sometimes evidence shows this isn’t the best way forward.

The overuse of antibiotics is another good example. Family doctors see a lot of parents bringing in their kids complaining of painful ear infections. Most ear infections are caused by viruses, not bacteria. But “just in case,” it has become habit to prescribe antibiotics, which are only effective against bacteria. This doesn’t help our patients and, in fact, pain-relieving over-the-counter medications can better ease the child’s pain.

Antibiotic misuse harms us all and studies show it has led to the spread of powerful, antibiotic-resistant superbugs.

In these situations, where doing a test or treatment can cause more harm than good, I try to reassure my patients through a good conversation.

There’s a big body of evidence behind the power of communication. Good conversations between doctors and patients is good for patients’ well-being. When patients feel their doctor has communicated well with them, they report a better understanding of their health problems and treatment plan.

Good communication also makes patients and their family members feel happier with the care they received.

A study led by a group of Ottawa researchers found that when doctors and patients used decision aids to help foster conversations in areas of clinical uncertainty, patients feel less conflict and uncertainty, and more confidence about difficult medical choices.

Another study surveyed family doctors across the United States about barriers to reducing unnecessary care in their own practices. The doctors pointed to a lack of time to have a good conversation during the clinical encounter.

But patients have a right to ask questions about necessary and unnecessary care options that can open the door to a healthy conversation. That’s why Choosing Wisely Canada put together some ways to start the conversation between patients and doctors.

So whenever you are offered a test or treatment, ask:

• Do I really need this test, treatment or procedure? • What are the downsides? • Are there simpler, safer options? • What happens if I do nothing? A good conversation with your health provider shouldn’t take a great deal of time. Doctors and patients want to make best use of the precious moments in a clinical conversation. Asking these questions is a good way to start. It’s all about the art of medicine.

Dr. Lynn Wilson is an expert advisor with EvidenceNetwork.ca, a family physician at Women’s College Hospital and is vice-dean, Partnerships at the Faculty of Medicine, University of Toronto. She is also the primary care colead for Choosing Wisely Canada. Distributed by Troy Media.