Two-sided conversations: A crucial part of patient-clinician interaction

It’s helpful when clinicians provide patients with basic information about their various treatment options. According to a recent analysis published by Health Affairs, however, patients benefit the most from patient-clinician interaction that involves an actual back-and-forth conversation.

“Our group has come to understand that the challenge of evidence isn’t simply communicating what we know clearly to our patients—although that alone is a significant challenge,” wrote Victor M. Montori, MD, professor of medicine and lead investigator in the Knowledge and Evaluation Research Unit at the Mayo Clinic in Rochester, Minn., and colleagues. “Instead, the real challenge is how to use evidence to discover what’s best for the particular patient in light of his or her circumstances and values. The medium in which this happens is patient-clinician conversation.”

When the authors summarized evidence on the medication options for patients with type 2 diabetes, they found that this wasn’t nearly as helpful to patients as focusing on how the various medications could personally impact the patient. If a medication often results in weight gain, for example, some patients may use that information to determine they prefer a different option.

“Patients were able to draw on the evidence to ask questions in conversation and come to decisions that made good sense for them,” the authors wrote.

Montori et al. said these patient-clinician conversations are more important than some providers may understand. This isn’t just about being friendly; it’s about making a legitimate improvement to the quality of patient care.

“We emphasize conversation in shared decision making not as a nice-to-have moment of interpersonal connection, but as an instrument of care appropriate to the uncertainties of illness and treatment,” the authors wrote. “Shared decision making is called for in situations in which the best option is not clear. These situations threaten the health of the patient, the expertise of the clinician, and the management of response. They are emotional in nature.”

Montori and colleagues also noted that clinicians must treat each situation differently.

“At times this may mean that the clinician takes a leading role—having been down a similar path with other patients,” the authors wrote. “At other times the situation may lead the patient to come to the fore in shaping treatment planning to his or her individual circumstances. How this happens depends heavily on the people involved: Ultimately, it is individual patients, families, and clinicians who will decide on a best course of action.”