Expectations Versus Reality

This week I want to share an article about patient-doctor interaction. This article addresses the fact that oftentimes patients have high expectations and what doctors can do to address what may be a difference with reality. Below you’ll find this article and my thoughts on its implication.

Disclaimer: The views and opinions expressed below are those of Mark Pew, Senior Vice President of Product Development and Marketing, and do not necessarily reflect the views of Preferred Medical.

How can doctors address patients’ expectations? 

Our culture has us programmed to want instant results, even when the problem or question at hand is complex and can’t always produce a simple, quick answer. In medicine, this is the case a lot of the time. Maybe patients have too high of expectations, or maybe the doctors do too, but either way this article explains ways that a doctor can address a patient’s expectations.

Mark’s Thoughts:
I recently reviewed some medical records for one of our claimants and noticed that the doctor included the following comment: “Patient’s expectations: become pain free.” Given the circumstances of injury and treatment, that’s not an option. And for someone in chronic pain, being pain free is potentially a life-long quixotic quest. So how can clinicians help create an acceptance of reality so the patient can adjust and manage the situation? According to this clinician: honesty, information, compromise, and options. This is the key takeaway—”Patients need to know the truth, good or bad. If we feel they are expecting something unattainable, we must balance their hope with reality. When we fail to do this, we take away the patient’s ability to make informed choices about their healthcare.” There were some excellent comments posted that furthered the subject:

Rosemary McKenzie-Ferguson: “I needed to know what the reality looked like for me it was my choice to go medication free this way I know the levels of numbness to over the top pain. I know what I need to be aware of and what I can dance with. My medical team understood that control of the situation was important for me. They have always been supportive and honest with me. People need to stop relying on pain control out of a package and find out what they can actually do.”

Jason Parker: “Thanks for posting Mark. Expectations is THE most validated, robust, and researched predictor of outcomes for both recovery and RTW. I would like to add that after interviewing over 1400 workers, and working several thousand claims that there is an additional step that sometimes people need to go through. Becky Curtis at Take Courage Coaching has experienced both personally and professional that sometimes the “hope” of the fix when the probability of the fix is low can dramatically hinder recovery. The true turning point for some is when they accept that this is how things are going to be. When we often see people make a breakthrough in their recovery it is not because they are ‘fixed’ or ‘pain free’ but because they have accepted their new life and this seems to help many move forward. I have observed that this acceptance actually helps create a internal locus of control but this needs to be supported in an empathetic way and the solutions need to be worker-centric (read: owned by the worker/patient). As Rosemary eloquently said “it was my choice”. We can’t make people accept this is the new norm…but we can certainly walk them through the steps to get there.”

Linda Breads: “Educate, Encourage, Engage and Candor. I learned many years ago in my ICU Days, Hospice Days and working as EMT, honesty as opposed to false belief does prevail. I found it actually lessened anxiety as patients were not expecting the unattainable, in many situations. While we may not want to hear” you may never be pain free” “There is no cure” “There is no treatment” we can now deal with the hand dealt realistically as opposed to “Why am I not better, is more wrong?” Or we seek out self diagnosis. All Practitioners and loved ones are always best served on the practice of honesty and not false expectations.”

Kathy Hubble: “I don’t believe we can truthfully say that a person will never recover from chronic pain or be pain free. Their goals are personal and we should encourage them to strive for what they want to achieve. If we place negativity upon their expectations then we are in effect contributing to their frustrations. I believe we need to help them break down their goals into achievable chunks and help them work towards their goals. They also need support and encouragement on the steps they achieve. If the expectations are that they can’t move unless they are pain free, then these expectations need to be shown to be unreasonable, and explain why.” And this was my response … “Well said and I don’t disagree. My point was that unrealistic expectations, not confronted honestly, can be a setup for failure. And how the clinician(s) engaged in their care can help in that assessment and towards an individualized plan. My sincere hope is that nobody has to deal with pain and my posts generally try to encourage a positive outlook, self-management and empowerment.”

To read everything on my mind this past week, please visit me on LinkedIn at https://www.linkedin.com/pulse/marks-musings-march-4-mark-rxprofessor-pew/.

Until next week,