The majority of patients are clueless as to what their role is in the clinician-patient relationship. Whilst this cluelessness can transcend a patient’s gender identity, racial identity, sexual orientation, educational level, socioeconomic status and age, to name a few, it disproportionately impacts marginalized communities.
I find this cluelessness troubling. It’s a real problem and I’m curious to learn more about the phenomena, so over the coming weeks, I’d like to share findings from a research study I recently conducted with patients in both the U.S. and U.K. The aim of the research was to better understand what the patient believes their role to be in the clinician-patient relationship, more specifically, how their own degree of participation in sharing information with a clinician influences their perceptions of their clinician’s degree of cultural competency.
What kind of information am I referencing? The kind that is sociocultural in nature and/or related to the patient’s personal preferences, so aspects of one’s health and well-being that do not involve explicitly expressing physical pain and symptoms.
Does the patient believe it’s their responsibility to share information about themselves with a clinician? Do patients know what is expected of them?
The majority say no or undecided.
In fact, 43% of patients report that they are either undecided or disagree with the idea that it is their responsibility to share information about themselves; and 44% of patients express that they are either undecided or disagree with the statement that they understand what a clinician expects of them during a medical appointment.
Some common response patterns that helped explain patients’ sentiments were:
- “Clinicians don’t want to listen”: clinicians aren’t systematically asking questions about the patient other than those that explicitly deal with physical pain and symptoms. This lack of questioning causes the patient to perceive that clinicians aren’t interested in learning about them as an individual. One patient summarized it best with: “I expect to be asked about things they (clinicians) consider important. I don’t necessarily know whether or how to bring things up myself”
- “Clinicians don’t care”: several patients reported, “they (clinicians) rarely are willing or have time to listen and it makes one feel extremely invalidated that they never bother to read my medical records before meeting me for the first time so I have to tell them everything from the beginning, yet again!”
- “Clinicians don’t have the time”: patients are very much aware of and sensitive to the time constraints of an (average) 15 minute primary care office visit, for instance
Remember, these are patient perceptions. I am neither vilifying nor blaming the clinician community, rather, I believe that both parties, clinicians and patients alike, must gain awareness of this issue and should be engaged in rectifying the problem.
Why should we be concerned about this problem?
At the highest level, if a patient fundamentally doesn’t understand their role in the clinician-patient relationship, crucial conversations will not happen and when those conversations don’t occur, there is a heightened risk for medical misdiagnoses and proposing the wrong treatment plan.
Plenty of published literature supports the notion that synthesizing the clinician’s own biomedical knowledge with the patient’s sociocultural information and personal preferences is the best practice in formulating a diagnosis and treatment plan.
Is it fair and accurate to blame clinicians for this problem? Perhaps not. Most clinicians have providing high quality, patient centric care as their top priority, but the fundamental structure and policies of the health systems they reside in do them little favors.
If the average time allotted for a primary care office visit is 15 minutes, clinicians are burnt out with administrative burdens, overflowing patient panels and misaligned incentives for providing care, it’s unrealistic to expect a clinician to know how to both conceptually and practically navigate each unique patient relationship. Similarly, in that scenario, it’s unrealistic for a patient to have a clear understanding of their role, what type of information they should share, how to share information and when.
What can we do about this problem?
I’ve formulated and evaluated some ideas on how to address the problem, but I’m not ready to “solutionize” just yet. First and foremost, awareness needs to be increased around this problem and until that happens no viable solutions can be fully adopted.
Call me old school, but I believe if we can’t master the basics of communicating with patients, we can’t do anything else well in modern medicine even with the most cutting-edge health technologies and medical device innovations. So, let’s fix the problem not just put a band aid on it.
The clinician-patient relationship is not intuitive, it takes tactical work, day in and day out, so let’s give this issue the time and attention it deserves.