Box 1.

Whose condition is it anyway?

Reality check #1: There are very few situations where the doctor does indeed ‘know best’

Different people faced with the same clinical scenario may, for very valid reasons, have differing responses or make very diverse decisions. For instance, faced with a diagnosis of breast cancer, one woman may feel very strongly that she would like to have the breast removed, but the very next woman may feel equally strongly that this would be a catastrophic outcome for her. Both need the opportunity to talk this through, and to fully consider and understand the possible risks, benefits and outcomes of the various options, but may still end up making different decisions and living with the implications of this. Being coerced into an unwanted mastectomy may mean psychological and emotional consequences that could far offset prognostic considerations for that individual person.

Reality check #2: Most people that ask to be told what to do, don’t really mean it

In a busy clinic or surgery, and faced with a patient saying ‘I don’t know, what do you think I should do, Doc?’, it is understandable that we will frequently succumb and tell them. After all, we know what would help, and they asked, right? For some, this will be a genuine request, but before we assume this is the case, consider what happened last time they said this (and the time before that). Did they actually do what was suggested? If not, are you content to go through this cycle again (and again) or would you be better to try a different approach?

Reality check #3: Self-management is the norm

In the setting of living with long-term conditions, a person will spend just a few hours a year interacting with healthcare professionals and more than 99% of their time managing their condition themselves. We need to recognise that it is the person themselves that does most of the work and the clinician’s role is to support them. People who have the knowledge, skills and confidence to manage their conditions effectively are more likely to adopt healthy behaviours and experience better outcomes.

Reality check #4: Accepting the status quo contributes to poorer outcomes

Many people do currently take a passive role, are poorly informed or feel overwhelmed by their health or life in general, which may encourage clinicians to revert to traditional roles. However, we need to recognise that these individuals are still managing their health day to day, even if they may not be in a position to do this very effectively. We should not accept or collude with this status quo, as these inequalities perpetuate poor outcomes and can be addressed by different approaches or additional support.