Consider the disagreement you wrote down in the last module. Imagine the conversation with the patient you were disagreeing with. What was your goal during that conversation? If you're like most people, you probably only wrote down one goal. Possibly it was to convince your patient of your recommendation. Or maybe it was to wrap up the conversation so that you could run to the next exam room. But in reality, every conversation can serve many, many different goals. This might be a good time to talk about Dr. Hagen and her patient. Let's call him Michael. So Dr. Katrina Hagen is a pulmonologist who has seen Michael since he first presented with symptoms of emphysema, probably caused by his years of smoking. Before his symptoms escalated, Michael, who has worked in construction most of his life, had been in relatively good health. At the most recent visit, however, Dr. Hagen was surprised to learn that Michael had not received any of the COVID-19 boosters. Michael explained that he really didn't see the point because he already had COVID, which he found to be relatively mild. And he also didn't believe that enough research had been done about the safety of the shots. Look, I got the first two and they made me sick as a dog. I had to miss work, which also cost me money. Then I got COVID anyway. They keep rolling out new shots every two weeks, it feels like. Frankly, I don't like being their guinea pig. Michael, for a high-risk patient, the boosters are not optional. The vaccine safety has been extensively studied. And I might add that your bout with COVID would have likely been more severe without the vaccine. I remember asking Dr. Hagen what her goal had been in that conversation. She thought the answer was pretty obvious. COVID is deadly to patients with emphysema. I was simply communicating the basic facts. Interesting. To me, it seems Dr. Hagen might not have been completely clear about her goals. Although she said she was simply communicating the facts, she was probably hoping to influence Michael's behavior. Simply put, she wanted him to get boosted. But in addition to that, there's a variety of other goals that Dr. Hagen could have pursued. She could have used the conversation to build greater interpersonal trust or to make Michael more comfortable asking questions in the future. Achieving those goals would likely have improved the doctor-patient relationship in the long term and helped Michael trust Dr. Hagen's advice not just about COVID vaccines, but about other recommendations that she might have made. The problem is that often in disagreement, debating the facts comes to overwhelm all other goals. Even if you have all these goals in mind, consistently adhering to them is difficult. Everything from the clinician's genuine interest in educating the patient to the very real time constraints makes people want to counter-argue. It's important to note that goals also shift in conversations. You might start out with the goal of showing empathy and building trust, but when patients state beliefs that are factually inaccurate, it's difficult to resist shifting into a persuasion goal. Of course, patients have goals too, and they may similarly struggle to articulate or pursue them. Right. So perhaps Michael has already had a number of vaccine debates and now just wants everybody to stop telling him what to do. Maybe he feels discouraged about his health and he doesn't want to think of himself as a high-risk patient. Perhaps he has a long-anticipated weekend of fishing planned. Maybe this is one of the few activities that he still enjoys since his health has started deteriorating, and he doesn't want to be laid up with potential vaccine side effects. We also have to consider the distinction between short-term and long-term goals. Your short-term goal might be to give the patient all the relevant facts. Your long-term goal might be to build a deeper, more trusting relationship. Are these two goals aligned? Is the short-term serving the long-term? All right. So what can we do with all of this information? First of all, it's worth considering the multiple goals that any conversation with a patient might serve. Here are some examples. You might want to use your conversation to improve the patient's health and well-being, to develop your relationship with the patient, or to enhance their trust in the healthcare system and science in general. You might want to persuade your patient or influence their behavior, ensure their best immediate health outcome, or show care and empathy. Maybe you simply want to avoid conflict escalation, or you want to come to better understand the patient's life context. The question is, do these goals align with your patient's goals in the conversation? Because, of course, they also probably have more than one. So, for example, your patient might want to feel hopeful or to have their symptoms relieved. They might want to confirm that they're getting the best treatment or to feel respected. They might want to learn new information from you, or maybe they simply want to feel heard. Maybe they want to vent, or maybe they actually want to express their appreciation towards you. So it's important to ask yourself, are your goals compatible with your patient's goals, or are they at odds with each other? Are you pursuing your goals with intention during the entire encounter? Think back to the patient conversation you identified at the beginning of this module. At that time, we asked you to write down your own goals. Now, think about your patient. What goals do you think they had in the conversation? Even if you're not sure, try to brainstorm as many likely goals as you can. What are the most common goals that a patient might have in a conversation? What are the most common goals that a patient might have in a conversation? There are many topics in medicine where there's clearly a correct choice. Isn't it important to persuade patients to follow sound medical advice? So, persuasion is often the default goal in disagreement. Ironically, there's evidence in conversations where both people have a strong opinion that a person changes their mind only about 5% of the time. That is literally 1 in 20. Okay, so with those statistics, it sounds like persuasion is a fool's errand. Maybe, but a different way to think about it is that if persuasion is unlikely, what other goals can we pursue? I often think that the main goal of any interaction is building a bridge towards the next one, and the next one, and then the next one. Being overly focused on persuasion in the present can get in the way of the long-term by making your patient uneasy about future conversations. So, what I'm hearing is that it's important to keep in mind the variety of goals a conversation might have and then pursue them with intention. In the case of disagreement, it might be helpful to reconsider the goal of persuasion in service of preserving trust and strengthening the relationship for the future.

communication goals

medical conversations

COVID-19 boosters

patient interactions

healthcare professionals