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Kaleidoscope of the Heart: The art of calm persuasion

Rika Kayama

I have worked as a doctor for over 30 years, and one of the things that really feels "different to the old days" is that patients today have much more information and knowledge than before.

In the past, patients would usually agree to any tests or drugs that I would recommend to them, but nowadays, it is common for patients to respond with astute questions such as, "How much radiation would I be exposed to with that CT scan?" There are even occasions where the patient is more up to speed about the latest information than I am, as a result of studying about certain illnesses through books and on the internet.

However, on the other hand, I have noticed that there is a lot of information out there aimed at patients in general that overly emphasizes that drugs doctors prescribe are dangerous. In my field of clinical psychiatry, there are occasionally people who refuse to take any kind of drug after seeing messages such as, "Antidepressants cause dementia," or "Sleeping pills are addictive and you'll never be able to give them up."

Of course, it is dangerous to take drugs that are unnecessary. However, there are times when doctors need to make patients understand that taking a certain drug is in fact necessary -- and this is something that is incredibly difficult. The reason why it is so difficult is because there is a real risk of adopting a threatening tone with phrases such as, "If you don't take this drug, the problem could continue for a long time," or "If you start taking the drug after your condition worsens, it will no longer be effective."

Aggressive phrases such as these induce a sense of anxiety and mistrust in the patient. It is much better to explain the expected benefits of the drug, as well as any possible side effects -- and also what to do if such side effects arise -- in a calm and non-threatening manner.

I believe standard conversation is pretty much the same. Sometimes, when we want to persuade another person, we might resort to raising our voice or using strong language. However, if the other person then feels that they are being threatened, they might start to mistrust the person trying to do the persuading, and possibly shut down. If you want to persuade someone, it is necessary to speak slowly and politely and deliver your message one at a time.

Unfortunately, there are sometimes cases where you might manage to persuade a patient about the necessity of taking a certain drug, but subsequently, the drug might not work or side effects might emerge.

In such cases, it is best to take a deep breath, stay calm, and sit down with the patient, explain why the drug might not have worked, rather than making an excuse that the drug was absolutely necessary, and try to work out the next step. After 30 years as a doctor, I have learned that it is important to create a care setting in which the doctor tries not to preach or shout down at the patient. This is something that I will remind myself to keep doing this spring. (By Rika Kayama, psychiatrist)

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