Want to Understand Your Wound Care Patient's Perspective? Just Ask!

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by Ron Sherman MD, MSC, DTM&H

Several months back, I suggested that we could better understand our patients' actions (for example, why patients do not adhere to their treatment plans) by looking at the situation from the patient's perspective. What I failed to discuss – largely because it is a topic worthy of its own discussion – is the fact that one of the best ways we can see the world from someone else's perspective is to ask that person to share their view with us.

The Benefits of Understanding Your Patient's Perspective

As clinicians, we are privileged to be able to ask any question we want, and we will almost always receive a truthful answer, no matter how embarrassing that answer may be for our patients. I teach my students to take advantage of this privilege and ask all the questions they need to. Personal questions like "Why did you do that?" may not be part of the standard medical history, but these inquiries help us to understand patients' motivations and fears, and such questions may even help the patients themselves to better understand their own behavior.

In fact, even if we think we understand someone else's perspective, it is still valuable to ask them directly. They will usually be glad you are interested, and their response may even open your eyes to something you had not previously considered. Even if the patient simply confirms your assumptions, you will benefit from knowing for sure what their perspective is; no longer will your opinion be just an assumption, for it has now been substantiated by your communication with the patient!

Why We Should Ask Our Patients Personal Questions

As therapists, we need not limit our questions to our patients' physical health if we see value in addressing their emotional, environmental, or social health. Sometimes I ask personal questions to assist me in understanding my patients' mindsets – their beliefs and motivations. Sometimes I ask personal and professional questions simply to learn about the patient's world. In this way, I have learned about such things as the latest illicit drugs, problems associated with sexual transitioning, and the day-to-day happenings of life on an oil rig.

By asking questions that allow me to better understand my patients’ world, I improve my ability to address their physical and mental challenges. That is, I can be a better counselor, educator, and care provider. Even if I'm not entirely successful in achieving this goal, the practice of being inquisitive certainly has helped me to better understand other patients with similar backgrounds and has ultimately made me a better clinician.

What does this have to do with biotherapy or wound care? If I don't ask a patient who declines maggot therapy "Why?", I may never discover that he is frightened by the false notion that medicinal maggots are 2 inches long, as he was led to believe by the movie, "Gladiator." I can only remove obstacles that I know about, and questions are one of the best ways to uncover what I don’t already know.

Of course, it's important not to treat personal questions like small talk. These days, it is common and even acceptable to be asked by someone at a meeting "How was your day?" only to find, as you begin your response, that whoever asked the question has already walked away. Avoid this! If you are going to ask personal or probing questions of your patients, be willing to listen patiently, and follow-up with another thoughtful question or at least an acknowledgement that you heard and understand the patient's response. Never ask a personal question if you are not willing to deal empathically with a response that could come out in a torrent of emotion and tears.

Beyond the benefits I receive by increasing my knowledge about my patients, I believe asking questions about a patient helps to build bonds by demonstrating my sincere interest in that person, and by demonstrating my humility and willingness to disclose my lack of knowledge about that patient's particular way of life. Never underestimate the importance of the bond between the patient and their health care provider; this bond is built on the basis of trust, and trust is one of the most valuable tools you will ever have in achieving adherence to your treatment plan.

In summary, it is valuable to consider the world from our patients' perspectives, and to optimally understand their points of view, ask your patients directly. Sometimes you will be surprised by their answers; always you will be enlightened.

About The Author
Ron Sherman MD, MSC, DTM&H has led a long career at the forefront of biotherapy, pioneering the development of medicinal maggots for over 25 years. He is now retired from his faculty position at the University of California, but continues to volunteer as Director and Board Chair of the BTER Foundation, and as Laboratory Director of Monarch Labs.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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How we ask our patients their perspective can dramatically influence their answers. If they are reluctant to adhere to the treatment plan, they are likely to already be defensive. Parents typically ask unruly children "Why" questions, which is not the relationship I want with my patients. Rather, I am the adviser and they are the king. Try, "Several of my other patients are also reluctant when it comes to wearing compression. Please help me understand some of the reasons this advice is not as acceptable to patients as I expected it to be." "Would you be willing to take a little time to educate me on how the things I am recommending actually play out in your world? What obstacles do you face?"

You may learn that soaking in warm water is difficult for your patient because the water to his mobile home was cut off weeks ago, or that wearing compression makes your patient feel as if they are an invalid rather than a professional, because they cannot wear heels to work, or that walking is not safe in their neighborhood.

When you need a doctor, then you must be ready to discuss everything openly. In case of health consultants, it’s more like playing a role of counselor, educator and care provider. The best results can’t be achieved without enough knowledge regarding the personal life of the patients. So, I guess, it’s not unethical to go into personal life of your patient.

As a heart patient with 11 cardiac stents, I'm always being encouraged to exercise by my internal medicine doctor. And he can't understand why I'm reluctant to get on some kind of training program. After reading your essay, I wish my doctor would ask me why I won't commit to regular exercise. I mean go beyond whatever blow-off response I usually give and really dig deeper. The real reason I don't commit? I'm afraid. I'm afraid that during exercise, I'll jar some plaque off the inside of my arteries and I'll have a heart attack. I've been dealing with these heart issues for 25 years now -- all without having had an actual heart attack. Of course, I know what I have to do. I have to start out really slowly with walking and gradually increase my distance and endurance -- which would be great if it weren't always accompanied by the angina I experience on exertion. Mentally, I know fear is a good thing because it's the precursor to courage. Still, I don't want to die trying to be courageous.

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