When you hear “clinician-patient relationship”, what comes to mind? A small percentage of you may rival my enthusiasm, but for many, I suspect that trending topics like virtual reality, blockchain, artificial intelligence and machine learning captivate you, filling your news feeds. I get it, I really do! To be clear, all of these technological advancements are worthy of your attention, however, I often wonder why can’t changing the way clinicians-patients interact be THE new, hot topic?
In this series studying the clinician-patient relationship, an idea was introduced which suggests that the conversations not happening between clinicians and patients are putting patients at higher risk for serious medical errors like misdiagnoses, prescribing the wrong treatment plan or prescription drug, for instance. In essence, I believe it’s a root cause of why we can’t achieve the coveted, healthcare “triple aim” – improving the patient’s experience of care (including quality and satisfaction); improving the health of populations; and reducing the per capita cost of healthcare.
Article 1 helped to explain that role confusion is an underlying reason why crucial conversations are not happening between clinicians and patients during the medical appointment. Then, article 2 detailed, from the patient’s viewpoint, why patients tend to feel powerless in their interactions with clinicians and often don’t share information about themselves.
This article serves to explain that despite feelings of uncertainty, fear, and powerlessness, patients are willing to share information about themselves, but there are conditions!
Are patients comfortable sharing information about themselves?
Yes, 65% of patients I surveyed from both the U.S. and U.K. reported that they are comfortable sharing information about themselves, but this is contingent on how the patient perceives the clinician’s degree of open mindedness, empathy, sense of power and whether or not trust exists.
It’s important to remember that the type of information I’m referencing is 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.
It’s also worth noting that patients are keenly aware of the assumptions that may be made about them by clinicians and such assumptions dictate how comfortable the patient will be disclosing information about themselves. For example, one patient identifying as LGBTQ+ stated:
“It (whether or not I will share information) depends on if the clinician has already made a heteronormative assumption within the treatment window”
This comment means that if the LGBTQ+ patient believes the clinician has already assumed they are heterosexual, then personal information may be withheld out of fear of judgment, lack of trust and/or fear of consequences of imparting such information.
Do patients believe it is important to share information about themselves?
Yes! 57% of patients surveyed agreed with the statement that “I believe it is important to share information about myself with a clinician”.
In fact, I suspect this number would be even higher if patients had more clarity in their role! When asked the following, related questions, only 56% of patients agreed to the statements: “In general, I believe it is my responsibility to tell a clinician about about myself” and “In general, I understand what a clinician expects of me during a medical appointment (e.g. how much I should speak, how much information I should share about myself, the types of information I should share, etc.)”
So, what’s next?
I’ll give a simplified response as this question will be addressed in a forthcoming, stand-alone article.
First, and most important, is investing (money, time and people resources) in the creation of adaptable medical practices so all patients, regardless of gender identity, racial identity, sexual orientation, educational level, socioeconomic status and age, to name a few, feel welcome and at ease. Yes, the devil is in the details – everything from signage/visual cues to non-verbal behavior matters!
Additionally, as I’ve said before, the clinician-patient relationship isn’t intuitive so we shouldn’t treat it as such. Open mindedness, empathy, awareness of power dynamics and focus on trust building, shouldn’t be a “nice to have” requirement, it should be a “critical/”must have” requirement towards care delivery and in order to do these things well, it requires a commitment to education and ongoing learning in this topic area.
Lastly, as mentioned in article 1, we need to shift our way of thinking around obtaining patient information. Dynamic, systematic questions, other than those that explicitly deal with physical pain and symptoms, must be asked and invite the patient to respond. Yes, I’m suggesting that the static questioning on the medical practice’s paper forms and even those on web-based tools isn’t cutting it! In many cases, if the questions aren’t asked, the patient isn’t volunteering the information.
Your thoughts? Feel free to share them with me!
LinkedIn: linkedin.com/in/laurenchofmann and Twitter: @LaurenCHof