Creative consulting—you can make a difference

Our relationship with our patients is the key to self healing

Why do you want to be in the caring professions? To help other people, to make a difference in their lives. So what will it take to do it well? You already know that this needs technical knowledge, skill, and experience involving years of study and hard work to be able to use a range of tools such as drugs, surgery, and radiotherapy. But did you know that there is often another way of helping that can sometimes be even more powerful than these tools and can interfere with or enhance their action? It's you.

Human factors affect human healing. Medicine is (re)discovering that they can sometimes be more powerful than technical factors in creating the outcome of our care for good and bad—modifying rates of recovery, side effects, complaints, and costs. We will explore the why and how of you bringing a positive and healing impact in your interactions with your patient in a series of articles which will start next month. These will encourage you to reflect more widely and deeply on what is known about therapeutic and healing encounters and linked areas, such as communication skills, consultations, healing and placebo responses, psychoneuroimmunology, and other dimensions of holistic medicine.

To whet your appetite for the coming series, here are some reasons why creative consulting is important.

It is happening already—so wise up: You cannot meet someone without some sort of impact. You would be better to make it a creative and successful encounter rather than a disappointing and frustrating one.

It is humane, which is what patients and carers want: People think that medicine has lost its way, has become overtechnical, even dehumanised. Learn how to avoid this.

Sometimes you are the only medicine that will work: Remember your challenge as a professional health carer is often to relieve suffering on those many occasions when cure is not possible or is limited. You can learn ways to do that.

It is enriching: Patients, students, doctors, and carers say that when the human side is valued medicine gets more rewarding.

It is creative: Making good contact and then working it towards a good outcome can be one of the most rewarding and creative parts of the job, but it takes as much work as learning a musical instrument or painting. You have a creative and a scientific brain (or least two half brains in the right and left hemispheres). Learn to use both, and simultaneously.

It is our responsibility: The General Medical Council has condensed a doctor's duty down to 14 points. All 14 involve human skills, only two or three emphasise technical knowledge or skill.

You get better results: If you fail to establish a partnership based on trust with your patients you will get worse results and more side effects. Even the hard scientist in us has to take account of human dimensions if we want to be scientific. Do it well and remarkable things can be achieved.

You might do less harm: Serious adverse drug reactions are a major cause of ill health and even death. Learning to develop therapeutic relationships can reduce this risk. But beware. Bad consultations can also produce side effects.

It is more scientific: Research suggests that all sorts of context factors are constantly affecting our results, so better to know that than be knocked about by these forces unwittingly. Did you know that symbolism has strong impact—for example, injections are stronger than tablets, red pills are perceived as stimulants and blue depressants—and your confidence in the prescription can make or break it?

Because there is a mind and body link: Amazing links are being discovered between people's emotions and inner life and their resistance to disease and recovery. Conseqently the system of head doctors and body doctors needs to be changed. Anticipate this and start the process now.

The patient will be your ally: Self healing responses are innate to nature. Study and work with them and you will get better results. Ignore them at your peril.

You will do yourself some good: Your risk of burn out seems to increase if you have no real satisfying contact with your patients. Therefore learning to make rapid yet rich relationships is a self protective skill in a busy and pressured environment.

Enjoy the adventure.

The new series exploring creative consulting will begin in next month's issue.

David Reilly, lead consultant, Glasgow Homeopathic Hospital, Glasgow G12 ONR
Email: davidreilly1@compuserve.com


studentBMJ 2001;09:305-356 September ISSN 0966-6494