Mark Twain once said, “Whenever you find yourself on the side of the majority, it is time to pause and reflect.”

Sometimes we hear things so many times, we stop questioning their validity.

Don’t recommend, Prescribe! This is a phrase I’ve heard countless times. The premise is that doctors need to be assertive and confident in their prescribing habits. Don’t make wishy washy recommendations. You’re a doctor damnit. Prescribe!

In many cases, this is the right approach. There are certainly times when healthcare professionals need to be assertive and direct with patients, prescribing one course of treatment that’s in the patient’s best interest. But, is this always the best approach?

When does it infringe on people’s desire to be involved in their own healthcare decisions?

Do patients want to be involved in decisions that impact their vision, health or quality of life?

Research indicates the answer is a resounding “Yes!”

According to PEW Research, the third most popular activity on the Internet is looking up health information, which frequently involves patients seeking information on diagnoses, tests, and prescriptions after a doctor’s appointment. Research also found that patients who are not involved in their healthcare decisions are more likely to regret their decisions and less likely to stick with treatment regimens.

Studies done in hospitals found that when patients are involved in their care adverse events decrease, length of stays are shorter, and malpractice claims decline.

Despite numerous studies highlighting the benefits of patient-centered care and its correlation with better health outcomes and quality of life, fewer than half of patients are satisfied with their level of control in medical decision making.

In your own experience, how often have patients come to you because they felt their last doctor didn’t listen to them or didn’t take their concerns into consideration?

How often have patients come to you because their last doctor switched their contact lenses or medication without giving them a choice and they chose to seek care elsewhere?

Maybe you’ve been the patient in this scenario?

Why is “recommending” such a negative thing? We seek recommendations all the time. We ask for recommendations on restaurants, doctors, plumbers, mechanics, and on and on. How often in your daily life do you look to someone who knows more than you about something and say, “What do you recommend?” If it’s from a trusted voice, we’ll typically follow the recommendation.

From a psychological perspective, trusted recommendations are a “hack” our brain uses as a shortcut to make decisions.

But it’s also human nature to desire some control over our decisions. This includes healthcare decisions. Most people don’t particularly like being told what to do. We’ll follow someone’s advice whom we trust but being told “here’s what you have to do” often pushes us toward a state of resistance and sometimes even defiance.

Considering the above, why wouldn’t we want our doctors to present options and then recommend the best option?

There’s an entire science built around exploring the patient’s motivations for wanting to do something called Motivational Interviewing. The science shows that when healthcare professionals take the time  to better understand what’s important to the patient and then involve the patient in the process, the patient is more likely to follow through. Here’s a great book on the topic called Motivation Interviewing in Health Care.  

I’m not advocating for one side or the other, I’m just suggesting that sometimes the best approach is to be the director, and sometimes the best approach is to be the guide.

What’s important is the outcome. If you make a compelling case, you’ll likely “guide” the patient to the outcome you desired all along.

The only difference is the patient will feel like it was their decision. If that gets us to the desired outcome, I’m ok with that. Are you?

“Don’t recommend, prescribe” is premised on taking control as the doctor. Sometimes to get people to take action, a more effective approach is to do something that doesn’t always come natural to doctors – let go of control.