Dialogue between a doctor and a patient with a chronic condition

When a person learns about their chronic incurable disease, their usual worldview collapses. The beliefs and perceptions about themselves and the surrounding world, formed over a lifetime to meet the need to live in a safe environment, change. The person and their loved ones experience a strong emotional shock. In a difficult situation where the patient wants to have a complete understanding of the disease, interaction with the doctor is an important aspect. At this moment, the patient needs emotional support. Having comprehensive information helps the patient form an adequate attitude towards the disease. Sparse data from the attending doctor about the illness (for example, only the diagnosis is given), evasion of questions regarding treatment, condition during therapy, results, increase anxiety, create fears, and can create or worsen symptoms of the disease. If the doctor provides adequate information not only about the diagnosis but also discusses the treatment plan with the patient, informs them about the goals of the research and procedures, it creates a sense of involvement in the treatment and control of the situation. All this contributes to the person understanding their motives for recovery and forming a responsible attitude towards treatment and their life. The patient gains strength and meaning in solving important problems for them. When informing the patient, I take into account their individual characteristics: age, gender, social status, family situation, specifics of the disease, upcoming treatment, personality type. The principle of competence is important to me: to speak with each patient in a language they understand so that they can comprehend what is being discussed. My conversation with the patient always has key significance. It touches on important life issues, so I care about the place and time of the conversation. No one should interfere with our conversation, the intimacy of the conversation is very important. I choose a convenient time for the patient to talk. There is a rule that if the doctor does not have enough time, they should inform the patient at the beginning of the conversation so as not to abruptly interrupt it later. In my case, I allocate time correctly so that there is enough time and no reason to interrupt it. In the first stage, I usually provide just as much information as the patient can accept. Only then do I lead them to understand the serious change in their condition. Chronic illness often poses a real threat, and I do everything to prevent the patient from underestimating the importance of their behavior in treatment. On the other hand, excessive details can only worsen the patient’s severe emotional state. In today’s world, many patients want to receive complete and detailed information about their illness: they use special literature, the internet, and critically evaluate everything doctors tell them. Now I always ask what the person already knows about the disease and what they want to learn. Often patients can tell many myths and erroneous stories, which are also important to discuss to dispel them. I do everything to give the patient hope for new medicine, treatment, and the latest scientific discoveries. Hope is an internal resource for the patient to exist in a difficult situation of illness. Thanks to our new technologies, even a bold ambitious plan to defeat the disease becomes quite realistic!

Author: Luiza Nailevna Raztdinova, medical psychologist, consultant psychotraumatologist.