Hear my concerns and I will take your recommendations seriously
BMJ 2025; 388 doi: https://doi.org/10.1136/bmj.r182 (Published 05 March 2025) Cite this as: BMJ 2025;388:r182
I have been living with Parkinson’s disease for four decades and, as a result, am almost fluent in “healthcare-speak”. Since my first encounter with a neurologist in 1986, there has been a clear shift towards shared decision making, with various guidelines and recommendations developed to support this. Many include some version of ensuring that the patient’s values and preferences are given appropriate weight during the decision making process.
Of course, this is especially important when implementation of the treatment or action being decided on is entirely in the hands of the patient themselves. This is the case for most treatments in healthcare today.
The pros and cons
For this reason, I am surprised when I meet healthcare professionals who don’t seem to realise that the patient can always exercise their veto in treatment decisions. I was recently in conversation with a physician who wanted to prescribe me beta blockers, even though my heart showed no signs of disease. I asked what the most common side effects are. He explained that since the desired effect of the beta blockers is to lower the heart rate, many patients report increased fatigue. This made me concerned. I told him I am not sure that I want more fatigue in my everyday life. I already get more than I want from my Parkinson’s disease.
I asked what the specific benefits of beta blockers are likely to be for me. Instead of answering, the physician simply reiterated the recommendation to start beta blockers, and that one can also die from sudden cardiac arrest.
The currency of trust
I understand it is entirely possible that this statement is correct. And I am convinced that the physician genuinely meant well. But if healthcare professionals don’t take my concerns seriously and don’t answer my questions, it’s potentially less likely I will follow their recommendations. I would argue that one of the main currencies in healthcare is trust. It goes both ways, and has to be continuously nurtured.
How could this encounter have been improved? It starts with a shift in mindset and the rest will follow. Physicians must realise that they may never know if we patients take the medication they prescribe. Supporting our understanding of our own situation, health conditions, and treatments is an effective way to increase the possibility of treatment recommendations being followed. Listening to our concerns and really hearing them will help build the trust. Or, in short: take our concerns seriously and we will take your recommendations seriously.
What you need to know
Healthcare is based on mutual trust and respect
The best decisions combine the clinician’s theoretical knowledge with the patient’s experiential expertise
Patients can (almost) always exercise their veto when it comes to implementing treatments
Education in practice
How might you ask patients about any concerns they might have when discussing a new treatment?
How could you ensure that patients feel you are taking their concerns as seriously as clinical evidence?
Footnotes
Competing interests: none.