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00:00:00 - Surf's Up: Season 5 Episode 23
During SurfingMASH's wrap-up interviews from the EASL Congress (S5 E19), Louise Campbell and Mike Betel mentioned a session Mike co-chaired on challenges in provider-patient communications. Today, the other co-chair, Shira Zelber-Sagi and panelists Tom Marjot and Jose Willemse join Louise and Mike to return to this topic. 

00:13:34 - Discussing the EASL Congress session
Shira describes EASL Patient Synergies, a broad collaboration to develop open, solution-centered dialog focusing on what patients need in working with providers. Mike shares a key takeaway.

00:16:31 - Stigma in what doctors say to patients
This section covers the issue of physician saying things they do not realize patients find hurtful. If the patient would share their discomfort, the provider could adapt on the fly. Jose sees this as a two-way problem: patients do not share feeling, but when they do, most providers cannot handle them.

00:19:40 - Sending signals of attentiveness
This section covers the positive impact when the physician does something simple like turning off the computer screen and the reasons why.

00:21:06 - Preparing for a patient consult
Tom considers prior preparation and chart review vital to a successful consult. Panelists note how much more important the consult is to the patient compared to the provider.   

00:29:23 - Structural improvements for patient consults
To Tom, multidisciplinary treatment teams provide tremendous benefits in patient preparation and responsiveness, but Jose notes that many countries lack the number of nurses necessary to do so.

00:30:57 - Motivational Interviewing
Shira suggests that every physician learn the principles of motivational interviewing: asking open questions with no emotional valence. This enables the patient to share unhealthy behaviors. The panel agrees, noting that physicians can motivate and that they are most effective when tailoring to the individual.

00:38:10 - Food insecurity as risk factor
Shira asks Tom whether and how he addresses diet with his patients and, more important, he does build socioeconomic factors into the decision analysis. Tom says "Yes" about diet and healthy lifestyle, but, he says, not enough about socioeconomic issues. They agree that awareness of the impact of food insecurity  is growing and needs to grow more.

00:41:10 - Assessing mental health and quality of psychological life
The group considers the idea that a large majority of patients in a liver clinic have unmet economic or mental health needs, and discusses what to do to improve social engagement.  Tom identifies the three items patients in large studies say they seek.  The group discusses the idea that they see liver support groups, but  none are MASLD-specific.

00:46:03 - The value of lived experience in providing care
This section explores shared experience as a pivotal factor in patient-based supportive care, similar to viral hepatitis, where successfully-treated patients become integrated into the care community.

00:49:03 - Holistic metabolic disease support programs and wrap-up
Mike suggests that MASLD support programs take a more holistic approach that places MASLD in a broader context. Shira suggests adding a focus on mental health. 

As the conversation ends, two final themes emerge: (i) physicians maximize success by being actively curious in exploring each patient's needs; and (ii) joint goal setting is an excellent strategy to drive behavior change.

00:54:41 - Question of the Week
What structural or educational changes do you anticipate will improve provider-patient communication significantly, and will these changes require more from the provider, the patient or both?