What an honor it is to be able to care for patients. With each encounter, we get to meet new people, listen to their concerns, examine them, and hopefully help them find comfort and relief from their dermatologic condition. The way patients are scheduled in a busy dermatology clinic, we have to be able to do this efficiently and in a way that patients feel understood and heard.
One important aspect to consider is “What is a patient’s motivation?” This simple question can often provide good insight into a patient’s perspective of illness. Think about these questions the next time you see patients. What motivated a patient to call your clinic and make an appointment with you? What motivated them to keep their appointment (which may be several weeks from when they made their initial call)? What motivated a patient to bring their spouse or significant other to their appointment? What motivated a patient to switch care providers or clinics to yours?
A patient comes into your clinic for a new skin cancer screening appointment and is worried about a darkly pigmented seborrheic keratosis on their back. Although within seconds, you may recognize the lesion as completely benign the patient was concerned and dreading their appointment because perhaps they have a family member or friend who recently got diagnosed with skin cancer and had to undergo surgery. Maybe their motivation is that their spouse made their appointment for them worried about a melanoma on their back. One of my mentors always made it a point to closely examine and palpate any lesions of concern that a patient brought up and to tell the patient “I’m glad you came in today” and “If it is worrisome to you then it’s important to me.” One of the worst things you can tell a patient is “That’s nothing” or “You didn’t need to come in today.” Understanding a patient’s motivation here can help validate their concern and alleviate their fears.
A patient with psoriasis continues to struggle with active plaques on their elbows, knees, buttocks, and scalp. Despite many years of topical therapy, the patient has never been clear and switches dermatologists to you. Frustrated, their particular motivation may be that they are looking for more aggressive therapy that has not been offered previously. Perhaps they are beginning to have joint aches and are concerned about psoriatic arthritis and potential disability down the road. Here the patient’s motivation is to learn more about what their options are including no therapy, topical therapy, phototherapy, oral systemic therapy, and biologic therapy, and what you may recommend as a best next step. Often patients may have read something in a magazine, seen an ad on television, or saw something on social media and wanted to see if they would be a candidate for such therapy. However, understanding a patient’s tolerance for risk and treatment preference is important here as well. The patient may be motivated for more aggressive therapy but not quite ready for a biologic. We can often ask a patient after we have had a discussion of reasonable options, “What makes the most sense for you.”
Often in trying to understand a patient’s motivation, I initially ask them “What brings you into the office today” or “How may I assist you today” even if there are scheduling notes or if a patient has been referred for a specific reason. After that, I listen. It is important to hear from the patient in their own words and to allow them time and space to tell their story. In addition, throughout the encounter I ask “What other concerns do you have”, “What else are you concerned about”, and “What do you think may be causing this” as patients may not reveal their motivations and concerns upfront (or at all!). The more that we can connect with our patients and better understand their motivation, the better we can help them along their journey and meet their expectations.
Dr Huang is an associate professor and residency program director in the department of dermatology at Wake Forest University School of Medicine in Winston-Salem, NC.