In clinical conversations, asking what matters helps set the agenda for the consultation, and makes it more productive and satisfying

“Playing in the garden with my grandchildren and country walks with my wife”

“Being able to get out walking in the countryside to have space to think and breathe”

They are four words, but asking “What matters to you?” is at the heart of person-centred care. The question communicates so much and has the potential to give so much to the conversation, whether clinical or not. In clinical conversations, asking what matters, what the person wants to talk about or focus on, helps patients set the agenda for the consultation, voice their preferences, and sets the scene for shared decision making.

Being asked “what matters to you” shows that someone is interested in you, curious, and sees worth in developing a meaningful connection—all valuable things for anyone accessing health services. The value for clinicians is that consultations become much more productive and satisfying.

It’s more than just asking the question though. We need to think about how we listen to the response and what we do next….

It’s often said that many people listen to respond rather than to understand. Fall into this trap when asking what matters to someone, and we end up being pseudo-person centred, which is both un-constructive and disingenuous. We need to listen with unconditional, non-judgmental curiosity, even when we see patients choose options we wouldn’t choose ourselves.

Once we’ve asked what matters to someone, that should inform the rest of our conversation. It might mean we take an active signposting approach to other services—perhaps via social prescribing—that could help the person connect with what’s important to them. A coaching approach using problem solving or goal setting could help them take steps themselves to change their day to day lives. Or it can be used as a proactive approach towards supporting people to keep well via personalized care and support planning and perhaps a personal budget for someone with more complex and enduring needs. In a clinical conversation, it will help steer shared decision making conversations and put clinical management in context of the rest of the person’s life. This range of skills is covered in a new e-learning programme from Health Education England.

Today is What Matters To You day, an initiative already established in Scotland, having originated in Norway. This year it is being championed by NHS England. The challenge for us all is to take a day of enthusiasm and convert it into daily habits for all of us working in healthcare. From a behaviour change perspective, we know that’s hard.

We hear people fearful that these four words represent a can of worms being opened that they don’t have the time to deal with. But there is an argument that we don’t have the time to not ask the question. Following a clinical treatment pathway that doesn’t align with what matters to the person risks over-medicalization or overtreatment and the risk of harm. It also ignores other priorities in the person’s life that have a major impact on their ability or capacity to engage or impact on their health generally. It begs the question, if what clinicians have to say doesn’t matter to the patient, what is the purpose of medicine?

The reality is that what matters to patients is highly personal and often surprises clinicians; for instance the man for whom kneeling at prayer is a major priority in his life might reject the option of a knee replacement—which can sometimes reduce knee flexion—despite being a “good” candidate for surgery. A system which failed to recognize his preference and proceeded to operate would not only fail him—it would have wasted public money.

Our role in a clinical system is as catalysts and enablers so people are supported to develop the knowledge, skills, and confidence to manage their health and wellbeing, and the impact this has on their day to day lives. We can only do this by focusing on what matters to them—their priorities, their preferences, so we need to ask the question to find out “what matters to you?”

Alf Collins is the clinical director for the personalised care group in NHS England with a background as a doctor, commissioner, researcher and writer on all things person-centred.

 

Anya de Iongh is patient editor for the BMJ and works nationally and locally around person-centred workforce development and self-management support services.

Competing interests: Full details here.