SF General reserves judgment when coaching patients to help foster open, trusting relationships.
Whenever people hear “no,” they do the opposite. Everyone knows that doing crack is bad for them and also illegal. Us telling them one more time to stop isn’t going to magically make them stop. Instead, it will make them resistant and unreceptive to our coaching.
What We Tried
We withhold judgment and try to meet patients where they are. Instead of saying, “You shouldn’t smoke crack,” we say “How many stems do you smoke?” It shows them that we’re not judging—we just want to understand their behavior so that we can help them. Then rather than tell them to stop, we might ask them to smoke less. The same is true for diet. If a patient is supposed to eat a low sodium diet, but they don’t have a kitchen and can only afford canned beans, we’re not going to tell them not to eat canned food. Instead, we’ll suggest that they rinse those beans out really well before eating them to cut down on the sodium. It’s about harm reduction, not changing them overnight.
The fact that we develop relationships with our patients is evidence that it’s important to reserve judgment. Our patients feel comfortable telling us that they smoked over the weekend or haven’t been following their diet. Knowing that, we can continue to coach them in the most effective manner. We had a really hard patient a few years ago who used drugs and didn’t intend on stopping. He disappeared for a while and when we finally saw him again he told us that he had developed a great relationship with his primary care physician and stopped using—“Friday and Saturday weren’t worth going back to the hospital for 2 weeks.”
Reserving judgment helps us develop therapeutic alliances with patients much quicker. We’re probably the only health care provider they’ve met who hasn’t told them to stop doing this or stop doing that.