Manon Bolliger - What Patients Dont Say If Doctors Dont Ask: The Mindful Patient-Doctor Relationship

I would like to start by acknowledging all my patients, my students, fellow practitioners, and the researchers that have inspired me to write this book.

I couldnt have hoped for wiser mentors in the world of publishing than Mary Weinzenbach, Brendon Bouchard and Julie Salisbury of the Vancouver Authors Circle. Tracy Marcynzsyn who helped me with the original edits, Terry McGraw who knew how to turn the mots justes of my French-studded manuscript into silky English prose, and Michael McConkey who fine tuned this current edition.

Finally, my familys support has been invaluable in the writing of this book. This book could not have been written without the understanding and support of Leana and Janael, the enthusiasm of Sagan, the recommendations of Michael McConkey and the deeply supportive, calming inspiration of my partner, Tony Joyce.

The science of medicine must be deployed to elucidate the art of medicine; otherwise, medicine falls short, both as science and art.

Miller & Colloca, 2011

In our journey as health care practitioners, doctors and healers, we are challenged with regard to our purpose, not because we did not want to help people, or because we didnt believe that the science and practices of the day had something to offer, but because we actually met our matchour patient.

Those of us who are drawn to read this book realize that our patients are our teachers, and we need to step up. Science has given us tools and is today guiding our way to the inevitable conclusion that nothing is whole without all of its parts. There is no science without a subject, and there is no subject without a culture, paradigm and belief system. We can offer little without understanding the context of the whole, and we help only insofar as we resonate with the ideas and ideals of our patients.

Despite our schooling, education and ability to perform varied skill setsdefined as what we doit is how we do things and why we do them that touches us most. When we come home, we want to share the pleasure it was to help someone, or how openly we shared options with them, or how great and empowered they felt when they left the office.

It is always the human element, the part that has individual meaning that means anything at all. And for the patient, that makes all the difference. It is clear that the mind and heart are the guides of our greater potential to serve.

No one will argue with Harv Eker, author of the Secrets of the Millionaire Mind (2005), that successful entrepreneurs have a clear vision of their goals, and a daily practice to which they are accountable to achieve this goal. They prioritize their time and concentrate on the elements aligned to their vision. The entire business community applauds this approach and young entrepreneurs pay gurus of this vision thousands of dollars to be inspired to carve their own path to success.

But it need not be any different in the field of health care. We have the same mind; we just dont have the visionaries and gurus to help patients carve their own healing paths, at least not in the same numbers. As doctors, we are by and large all Lone Rangers disconnected from our patients experiences, in denial of our own, and limited by methods and technologies that are hardly inspirational, motivating and successful.

I am generalizing, but are we not subjected to the same pharmaceutical pressures and to the same magic pill society, as is everyone else?

Until the time we can serve as an inspiration and coach to the patient who really wants to take back their health, and wants to be fully responsible for the consequences of all his/her decisions, we will continue to practice medicine in a void, bereft of the key elements that really make the difference between sick and healthy.

As I hope I have convinced you, the SOAP form is fraught with the assumptions that lie at the base of conventional medicine. In fact, it has spawned a relationship between the doctor and the patient that is neither conducive to the restoration of health as research has shown, nor aligned with the factors at play in healing.

The patients subjective view of her/his symptoms, which in fact is formed by their understanding of and attributing meaning to the situation, is the prime motivator in improving and reconstructing their health. It is this subjective rendition wherein lies the power to create a new reality, and the possibility of establishing, through their own interpretation of the meaning of their symptomatology, a prescription for a change in their health.

The objective symptoms and findings are of minimal value when it comes to therapeutic outcomes. It is not the name of the disease that decides how it will be manifested or treated in a particular patient. It is decided by the patient and propelled by their alignment with the elements that favour internal healing.

The assessment is based on what we perceive is happening, which is informed by our theoretical frame of reference. There is nothing particularly scientific or revealing to come to a disease conclusion based on a set of symptoms that are typically associated with it. Nor is it much more of a stretch to prescribe the marketed solution for the disease. What is challenging, and far more rewarding, is to engage the patient in this process and become an agent in their healing journey.

The plan is thus the journey, a road trip leading to the destination. It is the doctor-patient relationship that is built of congruence of perception, aim and methoda key to aligning for success. In the research of M.J. Simmonds (2000), when discussing placebo, she states:

The congruence between the patients and practitioners beliefs about problems and treatments will potentially affect the patients efforts, enthusiasm and adherence to treatment, thereby further complicating efforts to distinguish between specific and placebo effects. (Simmonds, 2000)

If congruence can have such a big impact in expected results, lets work with that, regardless of whether it is a result of our therapies or the placebo effect.

Congruence is a GOOD problem to have!

This same author further emphasizes the importance of the context of healing and states, benefits of symptomatic treatments are due not to the treatment interventions themselves but to the contexts in which the treatments are delivered. (Simmonds, 2000)

We are talking about congruence and context, both heavily reliant on the doctorpatient relationship. Furthermore, expectation is a primary factor that has shown to affect results, Scientific assessment of benefits from symptomatic treatments, such as analgesic agents, has been based on the assumption that treatment interventions will produce predictable benefits in patients with a given condition that can be measured in aggregate statistics derived from randomized clinical trials and extrapolated to clinical practice.

However, placebo and nocebo research reveals that the context in which symptomatic treatments are provided, and notably the information communicated to patients, creates expectations that influence the observed outcomes in terms of which benefits and risks are defined. (Miller & Brody, 2011)

So in establishing our plan, we learn to take into account congruence, context, and expectation. These are all factors established in relationship and cannot be objectively measured. And further, we realize that it is not what we do that matters, it is the benefits that patients get as a result of what we do that counts.

From the perspective of the patient in pain, for example, it is unlikely to matter whether pain relief derives entirely, primarily, or not at all from the inherent or characteristic properties of the treatment. The treatment is beneficial insofar as the intervention plus the context in which it is delivered produces benefit to the patient.