Chapter 3.4: Match your agendas!

Unfortunately, we aren’t taught telepathy in medicine.

I think it would make history taking much quicker, but may also lead to some unfortunate home-truths about our patient’s opinions on us. Also how would consent work? And how much control would we have over which aspects of the brain we can access? And if it went wrong, would you call a telepathologist?

Anyway, that idea can bubble away until Tarantino finally returns my calls. The reason why I bring it up is because every interaction we have with a patient involves two agendas: the patient’s and the professional’s. It seems obvious but, actually, being aware of this can ensure you avoid miscommunications, prevent unnecessary worry and have a better outcome overall. I want to give an example that I saw on my GP placement.

(Yes, it’s been so long since I wrote that I’ve finished A&E, entered a new year and have started a new placement. I’ve been busy passing written finals 🙂 )

Baaaabyyyy vax doo- doo- doodoo doodoo

Firstly, baby shark is absolute gold dust for your paediatrics placement, trust me. It really should be taught as part of the NIPE, but that’s also for another day.

I had the pleasure of observing a very experienced GP and their approach to a vaccine-hesitant patient. The vaccine in question was actually the seasonal influenza vaccine and, despite being offered it yearly (due to an underlying health condition), this particular patient had not had it for a while.

The first positive lesson for me was how the GP introduced the topic even though the consultation was about something else. GPs see an enormous chunk of the population and so the idea of “brief interventions” can potentially have a profound effect on public health. By introducing the topic at the right time and exploring it, the GP tackled the issue without taking up time for another consultation.

The second thing I reflected on was the approach. As I alluded to, patient agendas can differ very wildly from ours which can lead to problems down the line. In practice, I’ve seen the best way to bridge this is simply to ask questions and make the consultations a discussion, as opposed to an interview. By simply probing as to the reasons why the patient hadn’t taken the vaccine, we discovered it was from fear of feeling ill after it. Not autism, not death, not microchips, none of the more extreme stances, just feeling ill.

Once the GP knew this, it was no longer a case of stabbing (or jabbing hehe) in the dark. However, the final lesson I took from this was how the GP advocated for the vaccine in a skilful, non-judgmental way. You see, this particular patient was hoping to conceive in the near future and so the GP brought up the idea of the dangers of influenza infection in pregnancy. They also brought up the point that all pregnant women are offered the vaccine because of this so, regardless of her underlying condition, it would be recommended to her anyway.

The patient’s reaction was wonderful to see: she admitted she did not know this, thanked the GP for informing her of this and said she would now seriously consider getting the vaccine. Maybe she will, maybe she still won’t, but overall the GP managed to:

  1. Introduce the topic at an appropriate time
  2. Adopt a non-judgmental, caring approach
  3. Explored the patient’s thoughts and reasons
  4. Gave them important information, assimilating what she knew about the patient’s current health (and desire to conceive)
  5. Did her duty to public health
    All in about 5 minutes!

Overall I thought this was a great example of how matching agendas, probing for underlying thoughts and being opportunistic can produce great results. As someone interested in lifestyle medicine, I often find myself shoehorning those conversations into any free space, which may have the opposite impact.

Also, sorry for being away but it’s good to be back. Happy New Year to my followers. If you’re still following me in 2022, drop me a message (even just to say hi) and let me know of anything you’ve enjoyed. Also, plenty of writing in the pipework!


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