Have you ever gone to the doctor’s office expecting to see the attending physician whose time you were paying for, only to be seen by a junior clinician instead? I have, and was furious. I neither made the resident, who was neither as familiar with me nor as experienced as my doctor, immediately walk me to the front desk to leave. As a totally blind, diabetic college student overcoming countless obstacles to be present for this appointment, I refused to see someone less qualified whose time I would have still paid full price for.
Situations like this and countless others demonstrate that we have an extremely dangerous empathy gap in healthcare that impacts everything from how patients are managed to how health professionals think about and understand “the patient experience.” Narrowing this dangerous chasm can lower healthcare costs, improve research and patient outcomes, and make us healthier, wealthier, and a more compassionate nation.
What exactly is this “empathy gap?”
In some ways it’s tied to language. It also directly results from the fact that although they are usually caring people, the professionals we consult with about our health don’t know—and aren’t trained to think about—how their patients live and work outside of the clinical setting.
The academic language of communication about patients and their interactions with most health professionals, is filled with terms like “non-compliance” and “Patient Engagement.” These terms imply that patients like you and me aren’t doing what we’re told to do by health professionals.
Is this often true? Absolutely. Patients often choose not to follow the regimens recommended by the consultants we hire to help us be or get healthy. There is plenty of data showing that diabetics, cardiac patients and victims of addiction don’t follow their regimens, for example.
Unfortunately, patients are often unable to follow the regimens health professionals recommend. They may not have the physical capacity to complete the regimens a specialist—who probably wasn’t taught to think about how patients manage disease at home or work—prescribes. Patients then return to the clinic to be called either “non-compliant” or “non-adherent” to these regimens even though we want to follow instructions – but can’t.
Health Professionals are Consultants, not “Providers”
Today’s language also misidentifies the role that health professionals take in most circumstances. Rather than providing health for us, they are primarily consultants with tests, tools and techniques we may or may not choose to apply toward being healthy.
Ultimately, only patients can provide ourselves health by following, and working with our health consultants on, our recommended regimens.
Arguably, the only people who truly “provide” health are those who write prescriptions, set regimens or carry out interventional procedures. We consult with these experts, whether nurse practitioners, or Doctors of medicine, dentistry, or physical therapy, for example, for their knowledge and technical skill.
They give us the opportunity to recover from injury or illness via procedures they carry out or regimens they prescribe. Once the procedure is done or the regimen started, we become increasingly responsible for maximizing any potential health benefits it may have to offer.
Health Professions Training Over-Emphasizes Clinical Experience
Data I presented in November 2015, shows that more than 50 percent of students at more than 100 health professions training programs get no experience of how patients live and work in the real world, even though patients spend almost all of our time managing our health at home, work, and play.
This problem is worsened because sources like the Medical School Admissions Review show that the health professions school admissions process incentivizes pre health students to spend more time in labs and libraries than with patients during college. Students’ limited extra-clinical exposure before or during training indicates that a noticeable portion of graduates from the more than 1200 US health professions degree programs I contacted only learn to manage patients in the clinic, not the real world.
Put another way, if you think your health consultant doesn’t understand (and isn’t asking enough about) your real world needs and concerns…
You may be right.
Some painful statistics highlight the gap between the time patients spend managing disease or disability in the real world and our clinical time with health professionals.
Data from the Centers for Disease Control and Bureau of Labor Statistics suggest that health consultants with the power to prescribe meds or other health regimens spend no more than 800,000 person years in direct contact with patients in the clinic.
Meanwhile, the Partnership to Fight Chronic Disease and National Consumers League indicate that Americans spend more than 150 million person years sick at home and work.
If health “providers” don’t know how their clients live and work, or lack the emotional intelligence needed to sell us on doing things that are healthy but not always fun, it is easy to see why patients don’t always do what we’re encouraged to, and why American’s bad health habits change too slowly when we’re told pills or procedures can fix problems our choices create, or complicate.
Immediate, Significant Change in Healthcare Vocabulary and Health Consultant Training is Needed
“Change” means better exposure of health consultants to how patients live and work. This exposure would help them gain practical empathy that people like the amazing volunteers who have helped me with my medical needs and others assisting millions of patients in the real world have gained. It also requires us, as patients, to walk out on any health professional who acts like a god and not a consultant whose expertise has great, but not infinite, value.
Effectively, if you feel your health consultant doesn’t listen to you, throw them out of the room as I did when I realized a post-residency clinical fellow hadn’t taken time to read my chart. I definitely reinforced my reputation as a “difficult” patient that day.
Without these changes, poor patient-health consultant communication will continue, dooming Americans to be sicker, miss more work, suffer more, and die earlier than necessary.