Every patient encounter is a negotiation. I was reminded of this mantra during today’s afternoon session on negotiations. It is easy to forget that negotiation does not mean two opposing parties each attempting to secure the one prize. It is instead a mutual agreement that involves compromise and satisfaction on both ends. Every patient encounter is a negotiation from a follow up schedule to medications to lifestyle changes. In order to be successful, providers need to be skilled negotiators. Prescribing eight medications may theoretically help with a patient’s CHF, but if a frustrated patient does not take any of the medications it is useless. Ultimately, a provider must negotiate with a patient to create a care plan that best fits with a patient’s condition, background, and willingness. Being persuasive requires building trust and tapping into emotions in addition to a logical approach.

An interesting point was raised during discussion after a powerful film about physicians ignoring mindfulness in favor of confidence. Is this trait taught through the culture of medicine or are physicians self-selecting to value confidence over being questioned? As a pre-medical student I worked with a fourth year medical student who shared his thoughts on how doctors think. His motto was “sometimes wrong, but always with conviction.” When he asked a question he did not want someone to answer with a wavering voice or second guess a statement. He wanted to hear a confident answer over the right answer- the way he believed a physician would respond. Diagnosis and clinical management certainly require a degree of confidence, but what is the balance between mindfulness and conviction? How can both of these traits be taught in a harmonious way to change a culture that values conviction without mindfulness?