Instead of reading, you could also just listen …
Change is regularly needed in medical circumstances.
For example, as soon as someone comes to the doctor, it becomes apparent, that matters cannot stay the same.
The different aspects of change:
They come with a problem that they want to have addressed. Otherwise, the health would not have deteriorated.
In this case, we as doctors offer interventions:
- either medically
- or surgically
- or via supported life-style adjustments
For those interventions to be effective, doctors sometimes require active changes from the patient:
- to follow a regime
- to take medication
- to quit something
- to monitor something
They experience the need for change directly, for example, when they need to recover after an operation.
Who is active in the change?
We demand change from the patient, as change is regularly needed in the treatment process.
And as doctors, the routine way is to see (paediatric) patients as the passive recipient of the alterations we are inflicting on their life.
In my opinion, herein lies one important reason, why the long-term adherence to treatment plans is as poor as 30%.
Who should initiate change?
In an ideal world:
- The child and the parent understand the problem
- They feel empowered to participate in a conversation about different treatment options
- They come away with “their personalized” treatment plan
- They understand that change is needed
- They accept this conclusion and make the plan their own
What makes joined change-management difficult?
But doctors frequently shy away from helping the child and the parent to develop their adjusted strategies.
Moreover, doctors frequently assume that the process would be faster, if we just tell them what to do.
We often think that we lack the time to help them to develop their own plan how to deal with the underlying problem.
Unfortunately, matters of health and disease are regularly complicated.
For a shared change-management, we would need to educate the child and the parent about the basic functions of the body.
This instruction costs time and energy. As we have previously seen: communication is complicated. In the end, we rather impose “our” or the “standard” treatment plan on them, and this never becomes “their” plan. And the parent and the child regularly do not expect otherwise.
“What would you do?”
Often parents ask this question, when it comes to deciding about the treatment plan. I assume that one reason is the fear of making the wrong decision. They do not feel equipped to deal with the uncertainty and want to delegate this responsibility to us. The parents know that something, needs to change. They typically want us to “make” the change. We should fix the situation, almost as if we had a magic wand, rather than them actively contributing here.
In a nutshell:
In any treatment, the situation (e.g. life, habit, …) of the patient needs to change.
In the following posts let’s explore two backdrops of change-management: persuasive communication and cognitive dissonance.
Communication lives on comments … fancy to share yours?