When people seek care, one thing that helps them is reorientation from how things may seem (based on gut feelings, reading, and advice) to how things actually are (current best scientific understanding). During this process of reorientation, clinicians can consider the diverse educational, financial, cultural, and psychological backgrounds of the people seeking their expertise. People seeking care are the decision-makers. Clinicians can work to improve the ease and quality of these decisions.
Clinicians’ views may be colored by a few uneasy patient interactions. A dialogue with patients regarding mental and social health opportunities to feel better and do more is welcomed by most patients and may facilitate recovery. The key seems to be the development of a relationship based on openness and trust.
The influences of stress (financial, housing, job, relationship, health, etc), distress (symptoms of depression and anxiety), and less effective coping strategies (worst-case thinking and fear of movement, for instance) on the degree of symptom intensity and magnitude of limitations for a given pathophysiology are well recognized but infrequently addressed in patient-clinician relationships.
One study assessed the attitudes of people seeking the advice of a hand surgery specialist and found that the surgeons’ attitudes were markedly different from both patients and the general public regarding the dialogue between patients and surgeons about mental health influences on illness (1). Surgeons underestimated the openness of patients and the general public to discussing mental health and willingness to work with a psychologist or psychiatrist. Surgeons were more supportive of the opinion that the placebo effect reflects the strong influence of psychologic factors in healing and that psychologic stress often is expressed as a physical symptom. People seeing a hand surgeon and the general public were not as aware of the influence of mental and social health on illness compared to specialists (hand surgeons), but they were more willing to consider and discuss mental and social health opportunities than their surgeons realize.
Another study surveyed attitudes and beliefs about opioids and opioid prescribing policies among patients presenting to an orthopedic hand surgery practice. Most patients were aware of the potential risks of opioids and support opioid prescribing policies that aim to decrease opioid misuse and diversion (2). The majority indicated that they would like more education on opioids and that information about prescription opioids should be provided to all patients in orthopedic practices. Patients with higher educational attainment reported a greater perceived importance of opioid prescribing policies.
Our research on partnering with patients is focusing on several areas:
- We are developing strategies for safe and effective alleviation of pain and optimal opioid stewardship.
- We are testing the effects of such strategies on alleviation of pain and opioid prescribing.
References
- Mallette P, Ring D. Attitudes of hand surgeons, hand surgery patients, and the general public regarding psychologic influences on illness. J Hand Surg [Am]. 2006;31(8):1362-6.
- Bargon CA, Zale EL, Magidson J, Chen N, Ring D, Vranceanu AM. Factors Associated With Patients' Perceived Importance of Opioid Prescribing Policies in an Orthopedic Hand Surgery Practice. J Hand Surg Am. 2018 Aug 16. pii:S0363-5023(17)32157-3. doi: 10.1016/j.jhsa.2018.06.118. [Epub ahead of print] PubMed PMID: 30122303.