Hidden biases can cause inequities in care, and health disparities and their consequences have been well documented by the Institute of Medicine and others.1 Research suggests implicit or hidden biases by healthcare providers help cause disparities, leading to adverse treatment and less quality for some patients.
Providers must know about their own implicit biases and barriers to communication in order to overcome them, Ms. Rose said. “Implicit bias provides a lens for viewing this dynamic. Attitudes people aren’t consciously aware of can impact the care they provide. It affects all of us.”
Environment of Empathy
Another presenter from the Hospital for Special Surgery, Adena Batterman, LCSW, MSW, senior manager for inflammatory arthritis support and education, encouraged providers to create an environment of empathic care as the foundation supporting a spirit of shared decision making. She emphasized that patients, too, are experts in their own illness experience, background and values. Treatment discussions, therefore, require two-way information exchange, which explores who the patient is in the context of their life and experience.
“In the monthly support and education program we developed for people with rheumatoid arthritis, we hear about patients’ perspectives and feelings about their illness and treatment and how they impact their coping with illness,” Ms. Batterman said. They include fear of medications and beliefs about them, symbolic meanings for patients about taking medication, and the meaning of having a chronic illness. Also, many patients are overwhelmed by information and lack self-efficacy, or have low health literacy. In order for patients to participate in decisions, providers must identify and consider these issues. While some patients clearly communicate these concerns in medical encounters, others only give subtle cues, and providers must be attuned to them, she said.
“Like our patients, we bring a complex interplay of experiences and feelings to every encounter, which impacts our decisions,” Ms. Batterman said. “We’re trained to cure, but what if we can’t?” she added. “It’s important to understand the impact patient loss can have on providers and how that affects our ability to provide empathic care.”
One effective tool: mindfulness training, which is a way of thinking that enhances focus and clarity despite the pressures of a busy day, helping clinicians listen more carefully to their patients, show compassion and approach problems in a fresh, open-minded way.
Assess Mental Health Issues
A further layer of complexity to patient communication involves considerations of mental health issues patients may bring to their encounter with the rheumatology team. Joan Westreich, LCSW-R, social work coordinator for the hospital’s Early Arthritis Initiative, said depression, anxiety and other mental health issues can impact patient–provider communication, the patient’s engagement with treatment, adherence and other outcomes.
