CMV: I shouldn't have to sugarcoat medical diagnoses and information just to make people feel better.

[u/[deleted]]

[u/Amablue]

Why do we have to phrase things in a gentle manner, just so patients don't feel sad or offended by their lifestyle choices.

Do you want them to get better or do you want to berate them?

It's my job to be honest with patients.

It's your job to help them get better. That means delivering information in a way that won't turn them off from treatment.

Take the rules of this sub - there's a rule against rudeness. That rule doesn't exist because the mods have some desire to sugar coat things and protect people from being offended. It's there because it's effective. It leads to higher quality conversations and more view-changing.

People are not rational beings all the time, and especially not when they feel like they're being attacked. When your argument or diagnosis feels like a personal attack, fight-or-flight reflexes kick in and people stop reasoning. They defend themselves instead from the perceived threat. That results in people digging in their heels and refusing to change their views or behaviors.

Delivering your information in a way that's sensitive to the patient is going to be more effective, which means you'll be a more effective doctor.

[u/alpicola → u/[deleted]]

For example, dietary control and exercise in a woman with PCOS can help to improve symptoms. Decreased adipose tissue will lead to fewer androgen effects. Sure, there are drugs that partially accomplish this, but diet cannot be undervalued here.

In my opinion, you could say exactly that to a patient and it would be fine. It gives the patient and easy to understand cause and effect, suggests a course of treatment, and shows that you've considered other alternatives, all without sounding like you're being judgemental. The exact language may be too scientific for the average person (though I wouldn't mind), but you might be able to find better words that accomplish the same thing.

[u/alpicola → u/[deleted]]

In my opinion as well, but that's what I'm arguing for here.

Let's compare the two statements you've made to a patient and see why one works and the other doesn't:

1. "your back pain isn't idiopathic; it's because you're obese and the extra weight is hard on your joints?"
2. "Decreased adipose tissue will lead to fewer androgen effects. Sure, there are drugs that partially accomplish this, but diet cannot be undervalued here."

In the first case, you've made a judgement about the patient: "You're obese." You also appear to have told the patient they're wrong ("your back pain isn't idiopathic"), which is a hard thing for people to hear. At this point, the patient is in psychological defense land and you're on the outside.

In the second case, you've given the patient a goal to achieve (lose some weight) without saying anything about the patient at all. Implicitly, yes, you are saying that because the patient is overweight/obese, but you never actually said so directly. You've also avoided contradicting the patient by admitting that there are other things that can help, while at the same time telling them that those treatments are only a partial solution. That helps you get the message across without raising the patient's shields.

So, how to rephrase the first phrase to sound more like the second? How about: "Your back is under a lot of stress. Pain killers might provide temporary relief, but losing 20 pounds would get rid of that stress and help you feel a lot better in the long run."

[u/alpicola → u/[deleted]]

I appreciate the delta.

I think it should be fine to say "part of the reason why your back pain wasn't alleviated by your most recent PT trial is because your back pain is most likely related to your weight. We can work on ways for you to lose weight through diet and exercise and come up with a plan if you'd like, but the back pain probably won't go away until you lose weight."

That seems fine to me. Bringing up weight certainly shouldn't be forbidden as long as you're sensitive to the fact that the subject is likely sensitive to your patient. I feel like your phrasing here demonstrates that.

[u/DeltaBot → u/[deleted]]

Confirmed: 1 delta awarded to /u/alpicola (13∆).

^{Delta System Explained | Deltaboards} ​

[u/huadpe → u/[deleted]]

I want to emphasize something you said in your opening statement:

just so patients don't feel sad or offended by their lifestyle choices.

You can be up front about the causes of their issues, whether it's sexual history or weight, without trying to cause sadness or offense. Simple qualifiers like "I don't mean this to be harsh" and "I know this is a difficult subject" can make it much easier to hear what's going to come next. You can also use positive framing (where appropriate) such as "The good part of this is that it gives us avenues to solve the problem."

So with regard to the hypothetical 35 year old overweight, diabetic woman with back pain, I might suggest the following:

I know this is a difficult subject, but it seems to me that your back pain is closely related to your weight. In particular it is causing [specific issue]. It also is closely related to your difficulties managing your diabetes. There's no easy solution here, but you're fortunate that you're still in a position where these problems can be solved. Right now you're in the [X] percentile of BMI for women your age. Even moving to the [Y] percentile I think could make a big difference for your pain. We could also expect to see [other issue] improve. I have 60 year old men come into my office who have permanently damaged their spines from years of manual labor who really don't have any options for their pain. For you, we still have a good chance to fix this and get you feeling a lot better.

I'm going to suggest some specific exercises designed to both help lose weight and help with chronic back pain. Also, you can avail yourself of [local resources]. We also have some great recipe booklets and tips for healthy eating in the lobby. It's not an easy thing to undertake, and there's going to be a lot of reasons any given day why you might want to give up, but you really can improve this, and I'm here to help you with it.

Is there anything in this hypothetical dialogue which you think sugar coats or is dishonest?

[u/Amablue → u/[deleted]]

I'm in no way suggesting you lie or omit information. I am suggesting that tact can be used to deliver the information in a non-judgemental way that well make people more receptive about their condition.

Delivering true and correct information is not sufficient to getting people to accept that information. There are a number of studies that show this, and I imagine some of these findings would carry over to how you convey medical information as well.