What does a patient-centered evaluation and treatment look like? The authors of a recent review used recent evidence to support a framework to guide clinicians. One of the most important initial steps a provider performs is reassuring the patient. This doesn’t mean sugarcoating the situation, rather, it is reducing a patient’s concerns and anxiety through verbal and non-verbal behaviors. You are establishing trust and providing the patient with a path forward. There are four primary components of reassurance: data gathering, relationship building, generic reassurance, and cognitive reassurance.
Data gathering starts by learning more about the patient. If our examination strictly focuses on objective measures, we will miss vital components of the case. The patient’s story, perspective, their goals, and values all provide clues for the development of the ailment and the best plan of care. Effective data gathering requires effective listening. Seek to understand the patient ad allow their answers to guide your questions.
Relationship building centers on trust. To effectively build trust, you need empathy.
Generic reassurance can be a good first step (many acute low back pain cases resolve on their own without intervention) but they can also worsen outcomes. Statements such as ‘trust me you will be fine; and ‘I’ve seen this before; you have nothing to worry about’ diminish the patient’s concerns and remove the individuality of their case. Generic reassurance can fracture a therapeutic alliance. It can be beneficial if used as a form of validation, such as ‘you are not overreacting.’ The goal is not to fuel anxiety, but rather, to provide validation.
Validation by a healthcare provider is associated with greater patient satisfaction and more open conversations, deepening the therapeutic alliance, and facilitating shared decision-making.
The conversation cannot stop at reassurance. This grows into cognitive reassurance and shared decision-making, facilitating a personalized treatment plan. All the steps build off of one another.