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Mistakenly Thinking Patients Are Seeking Your Advice
Often patients have already made up their minds before asking your opinion. They
are not actually asking for advice; rather, they are seeking support for their deci-
sion (Goldsmith and Fitch 1997 ). They seldom come out and directly ask for this
support, however. Instead, they will disguise it in the form of a request for advice
[e.g., How do you think I should tell my sister she’s at risk for breast cancer?].
Giving advice to these patients, especially advice that is discrepant with what they
have decided, could be perceived as offensive, and they certainly would not con-
sider it (Kessler 1992 ). Additionally, what sounds like a request for advice may
actually be a request for information that would allow the patient to make her or
his own decision (Kessler 1997 ): “Commonly this information concerns a way to
think about a problem rather than a solution” (p. 383). For example, “What do you
think I should do?” may be a request for information about the advantages and
risks of undergoing whole genome sequencing rather than asking you to make the
decision.
Thinking that Patients Will Listen to Your Advice
Patients usually will not take your advice. They might act as if they agree, but they
will privately discount your suggestions. Or they might say, “Yes, but...” and go on
to explain why your advice won’t work. Fine and Glasser ( 1996 ) point out, “What a
person tells himself is more valuable to him than anything you might tell him, even
if what you tell him is better” (p. 66).
Not Realizing You May Appear to Be Taking Sides
Advice will probably lead you to be identified with the family member(s) or friend(s)
who has made a similar suggestion (Silver 1991). For example, when counseling an
adolescent, your advice may seem to reflect his or her parents’ viewpoint.
Believing You Know Better Than Your Patients
While you may be an expert on genetic counseling, you are not an expert on your
patient (Cavanagh and Levitov 2002 ). Consider for a moment how much you think
a person would know about you after spending 1 hour together. Furthermore, “no
amount of empathy can replace the fact that the counselee has to make and live
with their decision” (Kessler 1992 , p. 14). As you gain experience, you will begin
to get a feel for typical or normative types of patient reactions and decisions.
Remember, however, that a typical reaction may not fit for the patient sitting in
front of you.
10 Providing Guidance: Advice andfiInfluencing Skills