Strategy to Improve the Doctor-Patient Relationship in IBD
Strategy to Improve the Doctor-Patient Relationship in IBD
We propose an approach to negotiation with such a patient that is adapted from a principled negotiation approach popular in business negotiation, but modified for the DPR. The first step to the patient who refuses or is reluctant to follow a recommended treatment is to understand the patient's fears, to address them, and to correct misinformation. This includes a stark reminder that the patient is the one with the disease. In other words, keep the patient and their disease process separate from the position they are taking with regard to treatment recommendation. Next is discussion of the manner in which the disease may be monitored in some agreed upon and objective manner using a biomarker target for follow-up. Examples of such biomarkers include C-reactive protein, endoscopic improvement, or other objective values such as hemoglobin, restoration of nutrition, or growth and development. Third is an agreed upon timeframe during which the patient and the physician work together to explore a different treatment (or no treatment). This interval should be long enough to achieve some measurable change in disease status, but short enough to allow for close follow-up and ongoing discussions. The key to this step is that the DPR is preserved. Finally is reassessment of the agreed upon objective marker and repeated discussion of treatment recommendations. If an alternative or complementary treatment strategy has achieved the agreed upon objective goal, such an approach to the patient's treatment continues until the next time period and assessment. But if the alternative approach did not achieve the goal identified, the patient (and physician!) may be sufficiently convinced to move to more conventional or evidence-based approaches (Figure 2).
(Enlarge Image)
Figure 2.
Approach to the patient refusing therapy. DPR, doctor–patient relationship; IBD, inflammatory bowel disease.
Putting It Into Practice: How to Negotiate With Patients Who Refuse Treatment Recommendations Using the Treat-to-Target Approach to Management
We propose an approach to negotiation with such a patient that is adapted from a principled negotiation approach popular in business negotiation, but modified for the DPR. The first step to the patient who refuses or is reluctant to follow a recommended treatment is to understand the patient's fears, to address them, and to correct misinformation. This includes a stark reminder that the patient is the one with the disease. In other words, keep the patient and their disease process separate from the position they are taking with regard to treatment recommendation. Next is discussion of the manner in which the disease may be monitored in some agreed upon and objective manner using a biomarker target for follow-up. Examples of such biomarkers include C-reactive protein, endoscopic improvement, or other objective values such as hemoglobin, restoration of nutrition, or growth and development. Third is an agreed upon timeframe during which the patient and the physician work together to explore a different treatment (or no treatment). This interval should be long enough to achieve some measurable change in disease status, but short enough to allow for close follow-up and ongoing discussions. The key to this step is that the DPR is preserved. Finally is reassessment of the agreed upon objective marker and repeated discussion of treatment recommendations. If an alternative or complementary treatment strategy has achieved the agreed upon objective goal, such an approach to the patient's treatment continues until the next time period and assessment. But if the alternative approach did not achieve the goal identified, the patient (and physician!) may be sufficiently convinced to move to more conventional or evidence-based approaches (Figure 2).
(Enlarge Image)
Figure 2.
Approach to the patient refusing therapy. DPR, doctor–patient relationship; IBD, inflammatory bowel disease.
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