Instead of reading, you could also just listen …
Typical inner storylines of the (paediatric) patients are:
- Disease is the result of guilt:
- either I am punished for my mistake.
- or someone else is to blame for my suffering.
- The most visible coincidence must be the cause of the disease.
- Nobody can help me.
- I must fight to get what I deserve.
- The doctor is not really interested in my wellbeing but merely in their earnings.
Why focus on mental shortcuts?
The goal for our conversation with the patient is for the (paediatric) patient to be motivated to follow through with any steps they need to do.
How can we achieve this?
We would need to discuss and improve the patients/ parent’s own concept of the disease. Our focus must help them to choose any change in their behaviour as the patient’s own treatment plan. We become more coach than teacher, let alone judge.
When we fail to help them to develop/ accept a plan as their own, their inner train of thoughts has a very long time (e.g., all the time in the world) to undermine anything we told them during a 15 – 30 min appointment.
In my opinion, herein lies another reason why the long-term adherence to treatment plans is as poor as 30%.
The mental shortcuts in detail:
The first mental shortcut (1: Disease is the result of guilt) will be discussed at length in a later post.
The most visible coincidence must be the cause
As medical specialists, we know that a coincidence is not the same as a correlation. Our patients are often not aware of this difference. A frequent explanation from parents is that the living environment must be responsible for the frequent ear infections and cough of the child. The fact that they are smoking in the proximity of the child is something they tend to ignore out of self-protection, and therefore they tend to disregard this as a possible cause of the problem.
Nobody can help me
This mindset in the patient and parent can be tricky to solve.
A patient in this state of mind, will not follow any advice because their inner voice keeps them, in a sense, “hostage”. The inner voice keeps telling them, that no effort of their own or the doctor has a chance to succeed. In this case, it would be mandatory to “unearth” these debilitating thoughts, and this would only be possible in a setting where the (paediatric) patient feels safe and welcome to speak their mind.
We would need to avoid any hint of judgement about the (paediatric) patients’ misconceptions of the working s of the body and of diseases. The patients’ thoughts are their valid ideas and as such they are “correct” internally. It is not relevant whether these thoughts are “wrong” from an “objective” outer point of view.
We only have a chance to help the patient further when we come alongside them in their perception of reality and when we put the effort in to understand their inner train of thoughts.
This does not mean to agree on everything they construct, but to “really” listen and to “really” want to understand their inner “mechanics” to become able to point out alternative ways of interpretation and to open alternative ways to deal with the apparent problem.
I must always fight to get what I deserve
This can lead to an outwardly hostile and even aggressive attitude towards the health care provider. This statement is a revelation of a minority complex and of sensation of unworthiness. In the inner train of thoughts of the patient (and parent) they hear accusations and patronizing. They then respond to this inner storyline with outward defensive and even aggressive behaviour.
The optimal response towards this would be again to aim to “hear” the inner storyline underneath the spoken word. The health care provider would need not to be taken aback by the push, that comes from the patient or parent, but to maintain an inviting and open attitude.
The doctor is not really interested in my wellbeing but merely in their earnings
This has also the potential to completely derail any attempt of a cooperation towards health improvement. Like the previous inner storylines, the first step would need to be to create a stable and secure environment, where this opinion can be ventilated. Only if the statement is in the open, the conversation about how to act on it can be started.
In a nutshell:
Inner storylines of the (paediatric) patients have a significant influence on the relationship between them and the doctor.
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