Once you’ve elicited your patient’s thoughts and feelings regarding their illness perspective, what should your first response be?

Patient: ‘I think I might have cancer. I’ve been passing gas a lot more lately.’

Key Concept: acknowledge your patient’s right to hold their own views and feelings

• It is reasonable for patients to have thoughts and emotions about their illness

How do I give an accepting response?

• ‘So, you’re worried that your gas might be caused by cancer’
• ‘I can understand that would might want to get that checked out’
• Patient: ‘Yes, my mother died of bowel cancer when she was 40, and I remember she was passing a lot of gas; I’m scared I’m getting it too’
• ‘Thank you for telling me that, it’s very helping to know your concerns’

1. Acknowledge your patient’s thought/feeling by:
   • Naming,
   • Restating, or
   • Summarizing
2. Acknowledge your patient’s right to feel/think by using legitimizing comments
   • Understand the patient without provoking initial defensiveness
3. Come to a full stop; use attentive silence and non-verbal behavior to facilitate further disclosure from your patient
   • Avoid the tendency to counter: ‘Yes, but…’
4. Acknowledge the value of the patient expressing their views

Instead of immediate reassurance, rebuttal, or even agreement, our initial response to patients’ contributions should be to give an ‘accepting response’

• AKA: supportive, acknowledging
  • Accept non-judgmentally what your patient says (not necessarily agreeing)
  • Acknowledge the legitimacy of your patient to hold their own views and feelings (even if you don’t agree)
  • Value your patient’s contribution

Exercise: What can happen if you attempt to reassure your patient immediately after they disclose their worries to you?

Avoid premature reassurance

• Reassurance is often given before adequate information has been obtained
• Avoid reassurance in these cases:
  1. Before your patient’s concerns have been discovered
     • May sound false or inappropriately optimistic
     • May be misdirected: are we addressing the wrong concern?
  2. Before you have developed rapport
     • May be interpreted as indifference or being dismissive
  3. Before you collect appropriate and relevant information
     • Your patient will not understand the basis for your assertion

Acceptance prevents premature reassurance

• By discovering and accepting your patient’s concerns, trust is developed and more information can be obtained about their illness and concerns before an opinion is offered

This allows the establishment of common ground as well as a shared understanding of your patient’s perspective

• Accept the legitimacy of your patient’s views and feelings
• Avoid being judgmental
• Other Functions:
  1. Responds supportively to your patient’s expression of thoughts and feelings
  2. Facilitates a patient response to obtain better understanding
  3. Values your patient and their ideas