When Patient & Provider Agendas Collide

In my last post, I shared about a recent community health panel where patients let future healthcare providers in on how they see important health-related issues in the inner city.  We learned so much that I thought I’d do another post or two on what was shared.

This time, let’s explore the tension between addressing what a patient wants versus giving them what (we think) they need.  Anyone who’s been in healthcare for any length of time knows there’s often a significant difference between the two.

For example, one physician mentioned his patients often show up with a chief complaint of “pain.”  His training has taught him to figure out what kind of pain they’re in, rate it on a scale of 1 to 10 and categorize it according to several choices he offers them.  The goal, of course, is to learn more to work toward a successful treatment plan.  That’s his agenda.

In this community (and others like it), though, frequently patients refuse, for one reason or another, to respond according to the choices they’re given.  When a physician asks a patient to place her pain in one of four “boxes”, she might just say it “hurts a lot” or use some other description for her experience.

Are they being non-compliant, “difficult patients”?

Probably not, actually.

The people in this neighborhood have been through a lot.  One man shared how he was jumped by a gang of teens and left for dead.  His skull was fractured.  He lost sight in one eye.  He barely made it.  People who are suffering want to know their provider cares.  In addition to recovering, that’s their agenda, and, it’s legitimate.

The provider above shared how unsettling it can be to realize that you’re not in control of your patients’ health.  In reality, they are.  Only they can take the medications you prescribe.  Only they can make lifestyle modifications.  Only they can choose to live with hope and faith.

We have to come to grips with our inability to change anyone, and, be OK with that.  We have to recognize that, to a significant extent, we’re not unilaterally in control of the patient encounters we have.

But how do we get there?

It has to start with finding our identity and security with Christ, not in how much we know, or, in controlling patient encounters and outcomes.  When we recognize that God is in control, we learn to take our hands off the wheel, asking him in the moment what his agenda is, and paying real attention to what our patients are looking for.

This is not to say we throw our professional judgment out the window.  We can’t give someone narcotics just because they want them.  That wouldn’t be loving.

When we see that God is in the driver’s seat, though, we can be more truly “present” with our patients.  As that happens, we enter into their stories with true compassion and learn to work with them as they share their pain and suffering.

This will not come without cost, of course.  I’m not talking about money.  I’m talking about the “cost” of listening with sympathy, slowing down and letting our patients (and friends and families) have a real role in our interactions with them.

But the greatest cost may be relinquishing the security we find in “knowing” how the encounter should go, instead being open to an agenda that differs from our own.  It always hurts to step down from the throne.

At the end of the day, though, it’s not about the patient’s agenda or ours.  It’s about both of us recognizing, and deferring to, a loving God whose perfect (if sometimes hidden) agenda brings life and healing to us all.

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