Say so when you don't know
Trust is built and maintained through awareness of limitations
There will always be times in medicine when we don't have the information to be correct or come to a reliable conclusion. It's a GP skill to tolerate uncertainty and be prepared to admit when there's a topic that we don't know about. Patients don't expect us to have all the answers, but it really enhances the patient relationship when we're prepared to demonstrate the limits of our knowledge by saying 'I don't know'
This also comes across to the patient as respectful of her culture given initial apprehensions about being judged for her belefs, and she thanks the GP for his sensitive enquiry- this then enables the onward discussion.
The outcome of the consultation is that the GP leaves the patient with statin information to help her come to a decision while he consults with Pharmacist colleagues to appreciate the potential interactions of statins with her current medicines. Both will develop new learning before reconvening to share the decision.
Marshall Marinker once defined the difference between the GP and the Specialist as:
The role of the GP is
To tolerate uncertainty
explore probability
and marginalise danger
In contrast, the role of the secondary care Specialist is
To reduce uncertainty
explore possibility
and marginalise error
The technique required is always to take on board the patients perspective and preferences and see if this can be incorporated into what we do know about the medical evidence.
The dynamics of any consultation is the meeting of the patient understanding of their problem and how we feel an evidence-based solution would be of value, and sharing how this could be achieved. This requires the flexibility to adjust from the Doctor's preferred choice.
Getting the diagnosis right is what we're aiming for, then we have to get the treatment right for the patient. Imposing a Western medical agenda just wouldn't work here.
One GP surgery had a tree outside, where a nesting Woodpecker had long since vacated. Patients would come to the surgery, get told what to take, then leave with their prescription on a shiny FP10 piece of paper. One consultation after the other, the GP knew what to do, what to prescribe, out they went after their six minutes.
Years later the tree succumbed to disease and needed to be felled. The tree surgeons found that the tree trunk was impacted by hundreds of prescriptions that had been stuffed through the hole the Woodpecker left, having taken the imposed advice and disregarded the treatment as it had taken insufficient account of what mattered most to the patient. If it wasn't what they felt they needed, the prescription went into the tree.
Shared Decision Making isn't about getting good feedback, being nice, or deomstrating care for patients. It does all of these anyway, but SDM helps patient adherence to the proposed management, having explored the feasibility of the best way forwards.
There's no point prescribing the correct treatment if it ends up in the tree.