What Patients Value

It is axiomatic that to most effectively treat a disease you must first establish a diagnosis. While good diagnosis is no guarantee of a great outcome, some form of poor diagnosis, whether incomplete or missed, makes a poor outcome virtually certain.

As such, diagnoses have long been considered the observable effects of a biological problem. This surface approach is the result of entrenched patient interviewing methods that consider a person’s history as a mere chronology of events rather than a rich source of inter-acting elements painting a vivid picture of his life.

As a noun, diagnosis is an end to some data-gathering process. However, as a verb diagnosis (literally "through knowledge") must be a systematic exploration of facts leading to the root causes of disease phenomena. Diagnosis, then, can be thought of as a strategic problem-solving process, the facts of which come from a knowledge model capable of factual outputs.

Mentally competent adults seek medical advice because of an intolerable level of uncertainty about dysfunctions that we can sense and that affect areas of our lives most important to us. From this view, diagnosis transforms from a hypothetical statement to a continual process of understanding a person’s life circumstances in order to make declarative statements of fact.

People seek a physician’s opinion to have the awkward, often obvious facts at the root of our dysfunction verbalized to us in a way that is emotionless, non-judgmental and compassionate. Patients value their problems being dealt with openly through a candid, informal conversation that makes transparent the thick cloud of disorienting surface effects and gets to the uncomfortable roots. Patients value trusting their physician who must comfort them and be confidential through this exploration. Patients value their physician’s selfless curiosity and want to understand them, not as packages of problems and concerns but as people who have problems to be solved and concerns of which to be alleviated. Finally, patients most value being guided and encouraged toward a restorative experience of vitality - sensing renewed energy.

To be open, build trust, understand and restore vitality the community of people delivering medical care must create and adopt models that radically change the social rigidity of the professional encounter in favor of those we aim to serve. These models of care stand a good chance of emerging from the interface between cognitive science, psycho-neuroscience and information science used in combination as descriptive and prescriptive tools for the person’s problems.