Clinician toolkit: Developing a Care Plan

The basis for every successful patient-clinician relationship is trust. Trust grows when both parties listen to each other and are honest about expectations. The internet and social media can easily spread misinformation, and it can be tempting to dismiss patients who have firmly held beliefs that are not evidence-based. Empathy is essential in all patient interactions, but particularly those with prolonged symptoms and chronic diseases (Chen A, Felt-Lisk S. Unpublished data. August 11, 2022).

Key points

• Validate the patient’s symptoms and their health experience
• Build trust to help align patient and clinician goals
• Recognize the limitations of biomedicalization
• Explain the need for multiple visits and allow for longer visit times in the future
• Use motivational interviewing to help patients move away from potentially harmful treatments (download PDF) (e.g., prolonged antibiotics) and towards a symptom-based approach
• Focus on improving individualized quality of life, not just on finding a “cure”
• Encourage use of patient symptom trackers (paper or digital app)
• Educate patients on where to find reliable information (download PDF)
• Recognize support groups may provide helpful emotional support but they may not be beneficial for all patients
• Make a follow-up visit to see the patient back in your clinic
• When possible, allow more time for visits

Use motivational interviewing to connect with patients

Motivational interviewing involves 5 steps that clinicians can use to connect with patients. It centers on open-ended questions (download PDF) and allowing patients to talk about their health decisions. For example, if a patient does not want to try a specific medication, ask “What is it about this medication that concerns you?” to give the patient an opportunity to describe their fears or concerns.

1. Express Empathy: acceptance of the situation can help facilitate change.
2. Develop Discrepancy: make connections to consequences by asking, “What is good (or not) about this?”
3. Avoid Argument: confrontation does not motivate people; ask for clarification if an argument is brewing.
4. Roll with Resistance: emphasize that choice and control are with the patient; invite reflection by saying, “This sounds important to you.”
5. Support Self-Efficacy: motivation occurs when patients believe change is possible; empower the patient to choose an action plan.

Focus on quality of life

History notes Hippocrates as stating, “It is more important to know what sort of person has a disease than to know what sort of disease a person has.” Knowing the patient can help the clinician shift from a recovery narrative to one that is more focused on optimizing quality of life and achieving specific health goals. This can help patients and clinicians recognize small improvements and setbacks. Rather than focusing exclusively on a diagnosis and a cure, clinicians can ask patients what is most important (download PDF) to them and try to manage those symptoms. Referring back to their goals, through multiple frequent visits, validates their experience and makes them an active player in their care plan.

Some clinicians recommend focusing on symptom management with tailored pharmacologic or nonpharmacologic support as appropriate. Keeping a symptom diary (download PDF), talking about risks and benefits and side effects of medications, and being willing to change course if a medication or other therapy is not working (Chen A, Felt-Lisk S. Unpublished data. August 11, 2022) were found to be helpful to physicians caring for patients with prolonged symptoms (download PDF).

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