Negotiating a Treatment Plan

Once you’ve come up with a diagnosis, you have to determine a treatment plan based on that diagnosis. A treatment plan is something you should arrive at with your patient, rather than handing it to her like a prescription. The more you involve your patient in planning treatment, the more likely that she will follow through with the plan.

Compliance was once a popular term for describing good follow up, but now that term is being gradually replaced with adherence, which implies less passivity. A patient chooses to adhere, whereas he is made to comply. Researchers have found that when clinicians and patients negotiate a treatment plan together, both adherence and clinical outcome are improved (Eisenthal et al. 1979). Lazare et al. (1975) have outlined an approach to negotiating a treatment plan that makes good sense, from which the following schema is adapted.

ELICIT THE PATIENT’S AGENDA

Your patient’s agenda may not be as obvious as it first appears. You can begin to elicit it with a simple question, such as

How do you hope I can help you?

Note that this is a less confrontational way of asking about your patient’s agenda than asking

What do you want?

What do you expect?

At this point, the patient may answer vaguely or put the ball back in your court:

I want to feel better.

I don’t know. You’re the doctor.

It’s often important to clarify what sort of information you’re seeking:

How were you hoping that I could help you to feel better?

TIP

Often, patients come into an interview with a few specific requests, such as a desire for medication, therapy, a community referral, a letter to their employer, and so on. Some patients may feel embarrassed about divulging their requests so blatantly and may need some encouragement from you:

Sometimes patients have a pretty clear idea of what they’d like, for instance medication, counseling, or a piece of advice about something, a letter to someone. (A normalizing response.)

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