One aspect of patient counselling I never really considered before entering medicine was the process of evaluating and meeting (or not meeting) patient expectations. There’s a popular acronym that gets taught in med school: “FIFE“. This stands for Feelings, Ideas, Function, and Expectation. It means you are supposed to ask patients about their emotions surrounding a medical problem, what they know about it already, how is it affecting their functioning, and what their expectation is from the medical encounter. Most people use FIFE when they run out of things to say as a medical student taking a history. Then they awkwardly go through that acronym in a robotic manner and patients look at them funny. I know because I’ve been there. Once you’re more seasoned however you can integrate these concepts into your history-taking and it becomes much more fluid and even unconscious – like the rest of medical practice.
Currently on an off-service emergency medicine rotation I am seeing the importance of managing expectations. Occasionally we get “frequent-fliers” coming to the ER. Patients with vague complaints and a long list of prior ER visits and investigations under their belt. I really feel for some of these patients. Some of them are just flat out crazy. But regardless, when someone comes in and “demands” a MRI you need to be able to mitigate their, sometimes unrealistic, expectations. Sometimes this can be awkward…
Another important area where this is applied is surgical counselling. There’s no better way to wind up with unhappy patients, and subsequently lawsuits, by operating on someone with unrealistic expectations. During surgical consultation it is important to outline how the proposed procedure will benefit the patient, but also its limitations. Truly, it’s all part of informed consent.
As doctors we want to make people happy. We want people to feel like they’ve had the best possible care. Part of this hinges on their expectations, and unfortunately some peoples’ expectations are unrealistic. It’s important to empathize with patients and understand their position, but sometimes you need to lay down the law. If you’re dealing with a reasonable person, thoughtful discussion about pros and cons as well as expectations will usually lead to patient (and provider) satisfaction!
Slice of Life 