Blog post by:

Gabriel del Carmen, MS2
McGovern Medical School

As healthcare providers (and healthcare providers to be), our vocation intrinsically requires a unique form of patient advocacy. We are equipped with scientific knowledge and clinical skills, and it is this expertise that affords us the privilege of patient and societal trust. After having demonstrated clinical competence, a physician is asked to operationalize their acumen on behalf of their patient’s wishes. 

However, patients often report feeling unheard by their physicians, expressing dissatisfaction with this lack of clear communication.¹ Just as disconcertingly, physicians overestimate the strength of their communication in these patient encounters, ranking them as “adequate” or “excellent.”² This perceptual disconnect is partially explained, I believe, by an insufficient understanding of patient goals and definitions of health and well-being.

Medicine, an institution with many arms, is incomplete without proper regard for these individualized goals and personal definitions of health and wellness. While medicine operates on an empirical and biomedical axiom, it remains aimless without clear orientation to patient goals. Without clear and effective communication between a physician and their patient, the tools at a clinician’s disposal may cause harm as often as they cause good.

Historically (and unsurprisingly), medicine has served a fairly uniform patient demographic.³ By its nature, medicine as an institution has favored those with access over those without. And access has been (and continues to be) restricted on the basis of income, geographic location, social stature, and so on. Patient goals and value systems, while always varying between individual patients, shared common developmental threads. A more homogenous population meant those who became physicians often shared similar backgrounds and cultural characteristics to those who could access healthcare. And, subsequently, medical decisions were often made on the basis of assumed value systems (in other words, without explicit consultation). 

As medicine becomes more globalized and patient populations diversified, this decision-making heuristic has proven maladaptive. Physicians and patients are both in agreement that the goal of healthcare is to promote health and well-being. However, these concepts of “health” and “wellness” are individually understood in light of their social, cultural, spiritual, and interpersonal connotations. 

Two patients with a terminal cancer diagnosis may conceive of vastly different treatments from one another. One may define the healthiest path forward on the basis of their religious belief system, characterizing their health as coming to terms with their diagnosis on spiritual grounds. Perhaps the other patient values comfort over longevity, understanding their health in terms of the minimization of suffering. If the physician does not provide the space for these patients to communicate how they understand health, both patients may leave feeling unheard, discontent, and asked to follow a treatment regimen they would have liked to avoid.

This is a tangible harm for patients. Beyond the immediacy of this failure of communication, the continued erosion of the patient’s faith in their relationship with their provider renders treatment ineffective. 

A great deal of emphasis in our medical education is placed on apprehending those physiological, pathological, and anatomical realities. To truly begin the monumental task of achieving patient-centeredness in healthcare, our practices must reflect a more inclusive and holistic pursuit of healthcare goals and definitions. Regardless of where we are in the development of our career, we have a moral obligation to maintain a continued awareness of our patient’s beliefs, background, and values. 

Anything short of this is a disservice to our patients.

References:

1. Ha JF, Longnecker N. Doctor-patient communication: a review. Ochsner J. 2010;10(1):38-43.
2. Stewart MA. Effective physician-patient communication and health outcomes: a review. CMAJ. 1995;152(9):1423-1433.
3. Williams JS, Walker RJ, Egede LE. Achieving Equity in an Evolving Healthcare System: Opportunities and Challenges. Am J Med Sci. 2016;351(1):33-43. doi:10.1016/j.amjms.2015.10.012