“Is there somebody who’s willing to hold their hand at the edge?” - Bringing the Patient to the Center of Physician-Patient Communication and Decision-Making on Bone Marrow Transplantation
Abstract
Medicine is beginning to appreciate the value of “patient-centeredness”—healthcare
attentive to the unique characteristics, needs, and values of each patient—and a wide
body of evidence shows that physician-patient dynamics can have real effects on patients’
health. The patient-centeredness movement has led to calls for more equitable physician-patient
relationships, shared decision-making, and more individualized models of care. But
building all those requires fundamental shifts in the language physicians use to communicate.
I analyzed 20 conversations between patients and physicians specializing in bone marrow
transplantation for the physician-patient relationships that their communication produces,
and the effect of those relationships on patients’ decision-making ability. My findings
revolved around the “data dump”—that is, the physician’s nearly ubiquitous, depersonalized,
extended monologue on the biology and history of the patient’s disease, the array
of options available to treat it, and the risks and prognosis associated with each.
I found that “data dumping” can have one of two effects: leaving patients confused
and unable to decide on a treatment path, or silencing patients and preventing them
from actively choosing their treatment. Silencing and disempowering patients can in
turn prevent them from voicing clinically relevant information, and even from healing
as well as they would if they were empowered. I also found that physicians and patients
often had very different definitions of a “cure” and goals for their care; while the
transplant specialists were focused on the cancer, patients had their minds on their
lives as a whole.
Taken together, these encounters showed that patients need treatment options to be
individualized, contextualized, and delivered in a way attentive to their uniqueness,
autonomy, and ability to process information. The physician is the only person in
the encounter capable of fulfilling this need. Thus, drawing insights from a communication
theory known as Motivational Interviewing, I offer recommendations on how physicians
can humanize their information delivery and support their patients’ decision-making.
If put to practice, my analysis and recommendations can make medical information delivery
and decision-making more effective and equitable in a wide range of contexts.
Description
Critical Honors Thesis
Type
Honors thesisDepartment
EnglishSubject
doctor-patient communicationhealthcare
sociolinguistics
medical decision-making
risk communication
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https://hdl.handle.net/10161/3394Citation
Chhabra, Karan (2011). “Is there somebody who’s willing to hold their hand at the edge?” - Bringing the Patient
to the Center of Physician-Patient Communication and Decision-Making on Bone Marrow
Transplantation. Honors thesis, Duke University. Retrieved from https://hdl.handle.net/10161/3394.Collections
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