It’s important for doctors to recognise that some patients may be intimidated and perceive inequality in the doctor–patient relationship, which can be exacerbated by doctors acting in a way that is perceived by the patient as condescending or patronising. if the healthcare practitioner is arrogant or impatient and believes they don’t have a responsibility to discuss the situation with the patient or explain the condition in terms the patient could understand). Finally, the doctor’s approach and communication style will influence their interactions and could have serious adverse effects on the patient ( e.g. In addition, a doctor’s emotions may get the better of them or their behaviour might be affected by a lack of sleep, hunger, their own health status, lack of job satisfaction or other concerns. Healthcare setting (either outpatient clinic or wards) is a familiar setting for doctors to have difficult conversations, whereas for patients, it can be uncomfortable and sometimes awkward, especially if they are at the point of receiving their diagnosis. In a complex clinical case, doctors may seem so preoccupied with finding the solution to the clinical problem that it is sometimes easy to forget that the patient might be overwhelmed by anxiety, frustration and negative emotions, and require re-assurance to feel safe, at ease and trust in the doctor. Insufficient time further impacts the consultation as there is not time for the patient to verbalise, and for the doctor to appreciate, the valuable contribution that the patient brings in having the lived experience of the condition, especially if this is a rare disease. What is the patient actually afraid of? What do they want to know? What are their experiences? These are questions that will be overlooked due to lack of time. Overstretched clinic time may result in doctors not having time to actually listen to the patient’s concerns. Often, what is everyday routine clinical data to the healthcare practitioner may be completely unfamiliar to the patient, giving the impression that the clinician is cold and unsympathetic to the individual’s emotions as they try to come to terms with the diagnosis and its implications. counselling, palliative care, support groups and quality trusted information).īad news may be broken in a nonempathetic way, messages may be given to the nurses over the patient’s head while interrupting the consultation, difficult words may be used that the patient does not understand, and the patient may feel excluded from conversations with almost no concern showed for their feelings and emotions. Not referring the patient to appropriate support services/resources ( e.g. Being defined by their diagnosis and labelled as “a patient” is not, and should not be, the only thing in their lives. Patients often work, may care for children or parents, or have other commitments that may be impacted by the diagnosis or may have impacted on the timeframe in which they seek help, all of which will be going through their mind. Moreover, patients may also have other considerations to make, for example, if their diagnosis may impact on other commitments (professional, caring responsibilities, etc.). Language barriers, cultural diversity and their previous interactions with professionals or authority figures can also contribute to and affect interactions, and lead to misunderstandings. Patients can have very high expectations and trust in the system, and when it appears that their condition is a medical “dead end” or that their prognosis cannot be determined with precision due to the nature of the disease, it can be very upsetting. With increasing advances in medical research, expectations of the healthcare system and in healthcare practitioners have also increased. Such circumstances can, understandably, make a patient feel anxious, worried, hopeless and uncertain about their health, which can be displayed as tension and negative reactions towards the healthcare professional. They may feel that their illness is beyond their personal control, which can make them dependent on others’ help, particularly their healthcare professional. They may also have had negative experiences and previous disappointments within the healthcare system that may be challenging to overcome and may generate some mistrust.
Patients will walk into your clinic with a set of beliefs and expectations affected by their personality and the severity of their symptoms, and the implications of this for their quality of life. Each patient has their own medical and psychosocial history that understandably will affect their behaviour.
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