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Closing the Gap Between Patients and Rheumatology Providers: A New Problem?
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Calabrese
In a recent article published in JAMA Network Open, Levy and colleagues surveyed more than 4,000 patients and queried them as to whether they had ever withheld information from their clinicians.
And guess what? Most patients reported they had indeed withheld one of seven types of medically relevant information, especially when they disagreed with their provider’s recommendations or were fearful of being judged poorly about their behavior. My question to you is: Are you surprised? If not, why?
We all know there is a gap between patients and providers, one that has been elegantly documented by John M. Davis, III, MD, and his colleagues at the Mayo Clinic, over the past few years. In fact, I give this group my “Journal Article Title of the Year Award” for their paper published in Arthritis Care & Research, “Like No One Is Listening to Me,” which just about says it all in terms of the most likely etiology for this disconnect.
If you think about it, it really seems logical: If patients do not feel listened to, then why should they be candid or honest? Failure to be heard is tantamount to failure to be validated and thus, such interactions are less likely to be truly candid.
The solution to this conundrum? I again say that cultivating relationships with our patients can be the beginning of solving this disconnect. This does not mean being best buds, but it does mean that we take the time to get to know our patients as people. In fact, I say that this is one of the beauties of rheumatology practice and one of the sources of true joy in our work.
Last month in my editorial on burnout, I purported that when rheumatologists are allowed the time and space to do the things we actually went into this craft for, then the work becomes joy. While I may be getting a bit carried away, I think you know what I mean by this — fewer electronic medical record escape room drills, fewer pre-authorization smack downs and more relationship-centered care.
Let me close by recommending a great new book, The Empathy Effect, by my friend and colleague, Helen Reiss, MD, associate clinical professor of psychiatry at Harvard Medical School and co-founder and chief scientific officer at Empathetics Inc. I urge you to read this book as it not only outlines the science of empathy, but also breaks it down in an approachable way and makes you want to refine your own efforts to bring this capacity to the patient care arena on a daily basis.
In her book, Reiss offers a mnemonic device in the form of “E.M.P.A.T.H.Y.” with a useful pearl for each letter; however, you will have to read the book to benefit from them all. One of her empathy tips is “H is for hearing.” The “hearing” she refers to is really about hearing the whole patient, by which she means our skill at contextualizing the meaning of the complaints.
I like to say that rheumatologists are very good at drilling into the chief complaint, but we often falter in our ability to root out the chief concern. When we have a relationship with our patients this becomes easier as the meaning of the patient’s pain, fatigue or blue mood becomes clear. When this is happening, I truly doubt that patients will withhold much in our encounters.
Tell me what you think at calabrl@ccf.org or through Twitter @LCalabreseDO.
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- Leonard H. Calabrese, DO, is the Chief Medical Editor, Healio Rheumatology, and Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, and RJ Fasenmyer Chair of Clinical Immunology at the Cleveland Clinic.
Disclosure: Calabrese reports serving as an investigator and a consultant to Horizon Pharmaceuticals.