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Dr. Goldberg:
Hello. This is CME on ReachMD. I'm Dr. Joe Goldberg, and joining me today is my friend and colleague, Dr. Manpreet Kaur Singh.
Welcome, Manpreet.
Dr. Singh:
Thank you, Joe, glad to be here with you.
Dr. Goldberg:
Ditto. So let's talk today for just a few moments about how to enhance patient engagement for better outcomes in major depressive disorder. And it sort of touches on things like, how do you use shared decision-making? A patient’s reluctant to try a new therapeutic and you're trying to engage their interest in that. How do you go about that, Manpreet?
Dr. Singh:
Oh, the psychology of failure, right? I mean, all of us are feeling demoralized when a treatment that we're hopeful for doesn't work. So it's not just the patient; we feel it too. There's a level of transference that's going on in the dyadic experience of presenting therapies and thinking about next steps. So I try very hard to be humble with patients and set appropriate expectations that, you know, we're on this journey together; we might experience some bumps in the road. Unfortunately, we don't have, you know, great diagnostic or treatment-targeting tools to help us beeline to the best treatment for you, but we will sure try with the knowledge and experience that we have to be able to arrive at something that's beneficial to you.
And, you know, when you express that to the patient, that level of humility, it actually really helps, because they rely on you to some degree to be in the driver's seat, but agency is really important for patients too. They need to feel the autonomy of raising concerns if something doesn't work and not to just kind of accept what is prescribed at face value.
So that's why every single patient encounter, I try very hard to be critical about whether or not the treatment that we have in play is working and be curious about it with my patient. I think that certainly increases engagement.
How about for you, Joe, what kinds of strategies do you use?
Dr. Goldberg:
Love your use of the word agency and, oh, the word empowerment comes to mind too. So how do you either engage patients? I'm going to have to borrow here from those home real estate reality TV shows where, you know, the buyer comes along, and then the Realtor is there and says, “Well, what are you looking for?” And the prospective buyer says, “Well, I want a 4-bedroom house with 5 bathrooms on a half an acre on a closed lot with a fenced-in backyard, a swimming pool,” and then your job as the real estate agent, I mean, as the psychopharmacologist, is to say, “All right, let me make sure we've identified together what are your must-haves and what are your nice-haves?” Patient usually says, “I just want to feel better.” Of course you do. I want a nice house. Imagine if you said to a real estate agent, “I want a nice house.” What does that look like? I mean, from a practical standpoint, what are the targets that we're going after? You tell me what you want, and then I'll tell you what's in the inventory, or I'll tell you what's feasible and manageable, and then I'll tell you what that's going to look like in terms of what we could implement. So you say, “I want something that's going to work fast, that has no weight gain, that has no sedation, no sexual side effects. It's been proven to work in other people when nothing else does.” You know, I'm hearing ketamine. “Oh, I don't want to do ketamine.” But you just described to me the 4-bedroom, 3-bathroom house that you want. And I'm telling you this is something that can deliver on what you're looking for.
You could sort of take that approach, again, empowering the patient with what do you want, and then present it as let me tell you what I think the viable options are. That's really the essence of shared decision-making. You tell me what you're looking for as specifically as you can and I'll tell you if and when and how I can deliver.
Instill hope, make sure the patient believes you understand what they're looking for, and then tell them what you can do. It’s the best we can do, and it often works.
All right. Well, this has been great. We're out of time. Thanks for joining us today, and we hope to see you again soon.
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