Podcast Summary
Patient Dismissal in Medical Field: Patient dismissal is a systemic issue rooted in medical education and disproportionately affects minoritized groups, leading to negative health outcomes
The issue of patient dismissal in the medical field is a systemic problem, not just the actions of individual negligent doctors. Dr. Raghishri Darwan's book "Unheard: The Medical Practice of Silencing" explores this issue from her personal experience as both a patient and a physician. She reveals that the foundations of patient dismissal are laid during medical school training and perpetuated by the medical system. Minoritized groups are disproportionately affected by this issue and suffer negative health consequences as a result. The book offers a clear and compassionate approach to understanding the factors enabling patient silencing and suggests ways for positive change at individual, institutional, and systemic levels. It's a compelling and enlightening read that should be required for medical practitioners during initial and continued training.
Epistemic injustice in healthcare: Minoritized patients can experience testimonial injustice, where their words are not believed due to social identity, leading to negative health outcomes and unequal care
Patients, especially those from minoritized groups, can feel deliberately silenced or preferably unheard in healthcare settings. This can lead to epistemic injustice, a type of wrong that occurs when someone is unable to effectively share or pass on their knowledge. Testimonial injustice, a specific type of epistemic injustice, happens when someone's words are not believed due to their social identity. This can result in a credibility deficit, making it harder for the patient to receive proper care and potentially leading to negative health outcomes, both immediately and in the long term. It's crucial for medical professionals to listen attentively and believe their patients, ensuring equitable healthcare for all.
Healthcare training: Traditional healthcare training can create a dismissive attitude towards patients, leading to misdiagnosis and mistrust. A shift towards valuing listening and holistic care can improve patient outcomes and trust.
The way healthcare providers are trained can lead to a dismissive attitude towards patients, which can result in misdiagnosis, mistrust, and avoidance of healthcare. The biomedical approach to medicine, which focuses on treating the disease rather than the whole person, can create a distance between doctors and patients, leading to rigid boundaries, paternalism, and a lack of empathy. Medical students, who are taught to see themselves as separate and special, can develop hubris and an excessive sense of pride, further widening the gap between doctors and patients. If healthcare providers were taught to value listening as a therapeutic tool and to provide more holistic care, they could shift their role from "fixers" to "healers," leading to better patient outcomes and increased trust.
Medical listening dynamics: Medical training and productivity pressures can hinder effective listening between physicians and patients, but most healthcare providers want to listen
The medical profession's history of doubt and power dynamics can hinder effective listening between physicians and patients. Medical training and language can perpetuate skepticism and distance, making it harder for doctors to truly hear their patients. The emphasis on productivity in modern medicine further exacerbates this issue by limiting time for meaningful interactions and creating stressful work environments. However, it's important to note that most healthcare providers want to listen, but the challenges often stem from their training and work conditions. Understanding this dynamic can help in addressing the issue and fostering more empathetic, patient-centered care.
Listening skills in healthcare: Doctors and medical students should reflect on listening abilities, medical education should prioritize listening skills, institutions should create private spaces and shift focus to 'healer' approach, recognizing and reflecting on uncomfortable consultations, seeking patient feedback, and addressing victim-blaming attitudes.
Improving listening skills in healthcare is crucial for both individuals and systems. At an individual level, doctors and medical students should reflect on their listening abilities, be aware of biases, and strive for better listening environments. At a systemic level, medical education should prioritize listening skills, social determinants of health, and reflection time. Institutions should create private spaces, provide regular breaks, and shift the focus from a "fixer" model to a "healer" approach. Recognizing and reflecting on uncomfortable consultations, seeking patient feedback, and addressing victim-blaming attitudes are essential steps towards better listening. Ultimately, it's the responsibility of the medical community to create an environment where patients are truly heard.
Effective communication in healthcare: Effective communication, acknowledging power imbalances, and promoting a diverse workforce can lead to better healthcare experiences and outcomes for all.
Effective communication is key in ensuring a successful healthcare consultation experience. Patients can prepare by bringing all necessary information, writing down questions, and considering bringing a support person. However, it's important to note that the power dynamic between doctors and patients can sometimes make it difficult for patients to feel heard. This issue, known as testimonial injustice, can also affect minoritized doctors and researchers. Repeated experiences of being ignored can lead to decreased self-confidence and hinder career progression. A more diverse medical workforce can help combat this issue and improve patient health outcomes. Research shows that patients may feel more comfortable and better understood by doctors who share similar backgrounds. For instance, a study from the US in 2023 found that counties with more black primary care doctors led to longer life expectancy for black people. Overall, effective communication, acknowledging and addressing power imbalances, and promoting a more diverse workforce can lead to better healthcare experiences and outcomes for all.
Diversity in medical research: Diversity in doctors and researchers is essential for better patient care and filling research gaps, but disparities in funding and structural barriers contribute to these gaps, necessitating decolonization efforts and power sharing. Patient voices and experiences are valuable but often undervalued in evidence-based medicine.
Diversity in the medical field, including doctors and researchers, is crucial for better patient care and filling research gaps, particularly for conditions that disproportionately affect minoritized groups. However, disparities in funding and structural barriers contribute to these gaps, leaving communities underserved. The imperialist and colonialist roots of global health have also left traces in the prioritization of research topics and approaches, necessitating decolonization efforts and power sharing. Evidence in medicine is ranked hierarchically, with objective data like meta-analyses and systematic reviews at the top. Patient voices and experiences, though valuable, often fall lower in this hierarchy, highlighting the need for a more inclusive approach to evidence-based medicine.
Bias in research evidence hierarchy: Objective, quantitative studies are prioritized over subjective, qualitative ones, undervaluing conditions with less clear-cut symptoms and impacting patient care negatively
The current hierarchy of research evidence in medicine prioritizes objective, quantitative studies over subjective, qualitative ones, including those that incorporate patient voices. This bias can negatively impact patient care and the value placed on certain diseases and their patients. For instance, conditions with clear, objective signs and symptoms, like heart attacks or brain tumors, are often seen as more prestigious, while those with less clear-cut symptoms, such as fibromyalgia or long COVID, are undervalued. This hierarchy can lead to doctors not fully listening to patients and not providing adequate care. The reception to this idea has been generally positive, with many doctors acknowledging the issue and recognizing their own experiences as patients. However, it remains to be seen how deeply ingrained this bias is within the medical profession. Working on this book has made the author reflect on her own approach to medicine, leading her to place more emphasis on listening to patients and valuing their experiences.
Active listening, empathetic listening: Listening attentively to patients, even without a cure, can be therapeutic and beneficial for their emotional wellbeing. Empathetic listening holds power in medicine.
Dr. Darawan's experience of taking a year off during the COVID-19 pandemic to study and write a book led her to a new appreciation for the importance of active listening in medical practice. She discovered that listening attentively to patients, even when she couldn't provide a cure, could still be therapeutic and beneficial for the patient's emotional wellbeing. This reflection led her to value every consultation and understand the power of empathetic listening in medicine. If you're interested in learning more about this topic, be sure to check out Dr. Darawan's book "Unheard: The Hidden Power of Listening in Medicine," which is a must-read for anyone in or interested in the medical field. Don't forget to visit our website, thispodwilldkillyou.com, for a link to the book and Dr. Darawan's author page. We'd also like to thank Bloodmobile for providing the music for this episode, and Liana Squalache and Tom Brifocal for audio mixing. And as always, a special thank you to our patrons for their support. Until next time, keep washing those hands!