There’s little point in being able to discover what the patient wishes to discuss, taking a good history, and being highly knowledgeable if you can’t make a joint management plan that your patient feels comfortable with, understands and will adhere to

 Effective explanations need to be:

(1) Based on information gathered about the disease aspects of your patient’s problems and

(2) Framed in terms that take into account your patient’s illness framework (ideas, concerns, expectations)

Problems in Communication

• Doctors often give sparse information to our patients regarding diagnosis, prognosis, and management
• Doctors and patients often disagree over the importance of medical information: doctors place emphasis on management, while patients focus on prognosis and causation
• Doctors often use language patients cannot understand, limiting a patient’s ability to take part in the consultation
• Patients are often not involved in decision-making to the degree they would prefer

Problems with Adherence

• Patients often are unable to recall information that we impart, and often have difficulty interpreting difficult messages
• Though some studies have stated patients recall 50-60% of what is told to them by doctors, the major issue is patients not understanding key messages:
  • E.g. ‘I took my steroid inhaler just like you told me to, but then I felt better so I didn’t take it anymore’

 Objectives for Explanation and Planning

• Gauge the correct amount and type of information to give your patient
• Provide explanations that your patient can remember and understand
• Provide explanations that relate to your patient’s perspective
• Use an interactive approach to ensure shared understanding
• Involve your patient and plan collaboratively to the level your patient wishes (increasing patient commitment and adherence)

The Content of Explanation and Planning

1. Your differential diagnosis and working diagnosis
   • Including both disease and illness issues
2. Your plan of management for your patient
   • Investigations
   • Treatment alternatives
3. Explanation and Planning with your patient
   • Review what your patient has been told
   • Negotiate a plan of action