What are the most effective ways to address power imbalances between patients and physicians?

Power imbalances between patients and physicians can affect the quality and safety of health care, as well as the satisfaction and well-being of both parties. Patients may feel intimidated, ignored, or dismissed by their doctors, while physicians may feel frustrated, pressured, or defensive by their patients. How can you, as a patient advocate, help bridge this gap and foster a more respectful and collaborative relationship between patients and physicians? Here are some effective ways to address power imbalances and advocate for patient rights and preferences.

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1 Understand the sources of power imbalances

Power imbalances can stem from various factors, such as differences in education, expertise, authority, status, culture, gender, age, or personality. They can also be influenced by the context and setting of the health care encounter, such as the time, place, urgency, or complexity of the situation. As a patient advocate, you should be aware of these sources and how they affect the communication and decision-making between patients and physicians. You should also recognize your own biases and assumptions, and how they may impact your advocacy role.

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2 Build trust and rapport with both parties

Trust and rapport are essential for effective patient advocacy, as they can reduce the fear and anxiety that often accompany power imbalances. To build trust and rapport with both patients and physicians, you should use active listening skills, such as asking open-ended questions, paraphrasing, reflecting, and summarizing. You should also express empathy, compassion, and respect, and acknowledge the emotions and perspectives of both parties. You should avoid being judgmental, confrontational, or accusatory, and instead focus on finding common ground and mutual goals.

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Scott Bradford RN BSN MBA

Clinical Quality Professional, I love to build and oversee Whole System Quality programs!
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I always found it effective to attempt to find an area of knowledge with my patients that they could understand and identify with and then use that world to explain what is happening. For example, if I had a patient coping with the aftermath of an MI, who maybe has some new cardiac diagnosis, and in my routine working with them I find that their hobbies include car maintenance, I can use metaphors to help understanding what is going on with their heart in terms of engines. It’s about taking the time to find a common language between caregiver and patient/families to level the footing where we can.

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3 Empower patients to participate in their care

One of the main objectives of patient advocacy is to empower patients to participate in their care and have a voice in their treatment options. To do this, you should educate patients about their rights and responsibilities, such as the right to ask questions, seek second opinions, refuse or consent to treatments, or access their medical records. You should also help patients prepare for their appointments, such as by making a list of their concerns, symptoms, medications, or preferences. You should encourage patients to speak up, share their opinions, and ask for clarification when needed.

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Scott Bradford RN BSN MBA

Clinical Quality Professional, I love to build and oversee Whole System Quality programs!
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I think this is a shifting tide in the American healthcare world. Millennials such as myself, and even more so Gen Z after us, are inundated from a young age with information. We grew up with the ability to educate and prepare ourselves with knowledge. We are also more likely to stand on the knowledge we have gathered. This is a double-edged sword however, as it has also lessened our trust and dependency on “experts” in a field, because we can read the words of the same experts our care team has read. So, validating the knowledge base of our patients is increasingly important, and assisting in bridging from knowledge to understanding into application in a patient’s specific case becomes the path that needs to be walked.

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Trish Skarulis Stallone

Sports physical therapist, Orthotic specialist
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I often counsel patients to prepare a list of three questions to bring with them to their orthopedic MD visits. In this way, they feel mentally prepared for the visit and empowered to know what they should get out of it. Sometimes we brainstorm together questions the doctor's expertise is best able to answer- as examples questions regarding medical prescriptions, the MD's opinion on advanced treatment options and how the patient's progress compares to the norms of other patients the doctor sees. In this way, the patient doesn't feel rushed along and understands how repeated MD followup visits can be informative and helpful- not just a formality.

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4 Support physicians to practice shared decision-making

Shared decision-making is a process that involves patients and physicians working together to make informed and personalized decisions about the patient's care. It can improve the quality and outcomes of health care, as well as the satisfaction and trust of both parties. As a patient advocate, you should support physicians to practice shared decision-making, such as by providing relevant and accurate information, facilitating dialogue, clarifying values and preferences, exploring options and trade-offs, and reaching consensus or agreement.

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5 Negotiate and resolve conflicts

Conflicts can arise between patients and physicians due to power imbalances, misunderstandings, disagreements, or unmet expectations. As a patient advocate, you should be able to negotiate and resolve conflicts, such as by identifying the root causes, interests, and needs of both parties, generating and evaluating possible solutions, and finding a compromise or a win-win outcome. You should also be able to manage your own emotions, cope with stress, and seek support or mediation when needed.

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Scott Bradford RN BSN MBA

Clinical Quality Professional, I love to build and oversee Whole System Quality programs!
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Oh the importance of the nonjudgmental observer! Through sessions of counseling in dealing with my own perfectionism, pessimism, anxiety, and depression I learned the inexhaustible value of being able to the nonjudgmental observer of my own life and thoughts. The same is often true in the mediation of conflict. The ability of having someone sit in the space between thoughts and ask the needed, often probing, questions in a conflict is valuable in finding shared spaces of commonality between the parties to establish foundational agreements where they can be made. Rooting differences of opinion in the branches of a shared goal allows for better diversity within a team, these types of differences are the foundation of iron-sharpening-iron.

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6 Evaluate and follow up on the outcomes

Evaluating and following up on the outcomes of the patient-physician interaction is an important part of patient advocacy, as it can help assess the effectiveness of your advocacy efforts, identify areas for improvement, and provide feedback and recognition to both parties. You should ask patients and physicians about their satisfaction, concerns, or suggestions, and document and report the results. You should also monitor the progress and outcomes of the patient's care, and ensure that the patient's rights and preferences are respected and fulfilled.

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7 Here’s what else to consider

This is a space to share examples, stories, or insights that don’t fit into any of the previous sections. What else would you like to add?

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What are the most effective ways to address power imbalances between patients and physicians?

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2

3

4

5

6

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1 Understand the sources of power imbalances

2 Build trust and rapport with both parties

3 Empower patients to participate in their care

4 Support physicians to practice shared decision-making

5 Negotiate and resolve conflicts

6 Evaluate and follow up on the outcomes

7 Here’s what else to consider

Patient Advocacy

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What are the most effective ways to address power imbalances between patients and physicians?

1

2

3

4

5

6

7

1 Understand the sources of power imbalances

2 Build trust and rapport with both parties

3 Empower patients to participate in their care

4 Support physicians to practice shared decision-making

5 Negotiate and resolve conflicts

6 Evaluate and follow up on the outcomes

7 Here’s what else to consider

Patient Advocacy

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