Patients with chronic conditions may not respond well to the typical structure of a consultation. Is it a lack of motivation or a conditioned response of failure?

The Conditioned Response

Many patients who come in for management of chronic or challenging conditions often don’t respond well to the typical structure of the consultation. One reason may be that they have developed a conditioned response of “treatment is not going to help me.”

Let’s continue on from a previous post to explore the “Conditioned Response” versus a lack of motivation.

So How Does This Response Happen?

Patients dealing with chronic or challenging conditions have often seen a number of health practitioners. They are seeing you because previous treatments have not worked.

From the time of making the appointment to getting into the consulting room and going through the range of questions that are asked, the experience is predictable. I know. I’ve travelled around the country over the last 6 years. I’ve had to find new health practitioners in every city we go to live in. The pattern is same.

If this pattern is then linked to a poor outcome the patient learns that the sequence of events leading up to the treatment and the treatment itself will end up in failure. From this conditioned response they develop a belief that treatment isn’t going to help them. From Benedett’s work this could be referred to as a Nocebo response.

Before the patient sits down with you their brain is already priming itself for a failed outcome.

So What Hope Does The New Clinician Have?

 Well lots if they are prepared to think and do things differently. As Norman Doige so aptly put it “Cells that fire together, wire together”. This non productive wiring needs to be challenged in some way if there is to be any hope of you helping a patient with this learnt response.

How can you challenge entrenched brain wiring?

Anything you can do that is not typical will have the patient’s wiring a little ‘rattled’. Aim to do this as early as possible in the process of the patient getting to see you.

Try asking yourself these four questions:

1. How can you make the appointment process different?

2. How can you make the waiting room experience different?

3. How can you make the introduction process different? In all my travels I have never had a clinician come up and sit beside me to introduce themselves. If that happened to a patient with a chronic injury I’m sure they’d be thinking - “this is different.“

4. How can you make the start of the consulting experience different?

Here is a nice way of starting a consultation that will have any patient with a chronic injury thinking differently:

“As you know I have a number of questions to get through, but I’d like to put aside 5-10’ (you insert the time that best fits) and find out how this injury is affecting you and what you want to get out of our time together today and in the long term. I might go back to the form to fill in the gaps. Is that ok with you?”

Or Perhaps you could try this:

“I’ve a lot of questions to get through, but I find it easier to put this aside and ask you to spend the first 5-10’ just taking me through a recent/typical episode. I might go back to the form and fill in the gaps if necessary. Is that ok with you? I’d also like to know what you want out of our time together today and in the future?”

Beginning the consultation in this way together with changes in the way they went through the appointment process has at least some chance of ‘rattling’ that wiring!

It also means your listening skills must be highly tuned. You need to be able to get your information without having to go through the whole script after they finish talking. There will always be a few questions you will need to ask. If you can ask only the ones that are relevant, the patient will respect the fact that you listened to them and they felt heard.

Most patients would be starting to think that perhaps you can help them. This is because the process they’ve been through has been unlike any other.

The other thing that is really useful by starting this way is that you have put a frame around the talk time and they have agreed that after the specified time you will get back to what you have to do.

You will also get a clear understanding of what the patient wants out of the consultation now and in the future. You might be surprised to hear that it is not what you thought you would be providing.

If nothing else, by doing things differently you would have the patient who has come in to see you just a little bit hopeful that this experience will be better than those they’ve had previously.

If you can modify the belief that I mentioned at the start into-

“Perhaps this person can help me.”

You have at least changed a mindset of impossibility to that of possibility.

This post is taken from my website mindandbodyconsultancy.com

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Useful references:

Brain Science Podcast with Dr. Ginger Campbell

Placebo and the New Physiology of the Doctor-Patient Relationship by Fabrizio Benedetti

How Placebos Change the Patient’s Brain by Fabrizio Benedetti, Elisa Carlino and Antonella Pollo