Power hierarchies are widespread in healthcare. Different health professionals are placed in a hierarchy. Patients and providers are placed in a hierarchy as well. More specifically, patients depend on providers to suggest plans of treatment that could potentially determine their life outcomes - a sense of subordination for the patient. The provider, after all, is the one with years of training and expertise in a concept foreign and unknown to the patients and families.
The patient-provider relationship relies on a delicate balance of trust. Ideally, there is mutual respect between the two parties which results in better health outcomes and patient-centered decision making. However, this trust can be broken due to imbalanced power dynamics.
If the general population has a hard time speaking up in a patient-provider relationship, it can only be more difficult for disabled individuals, a group that has been systematically oppressed and degraded as being “less than.” Patients who are attentively listened to, respected, and thoroughly educated by their provider would be more likely to feel comfortable and open to self-advocating their opinions and values.
The patient-provider relationship relies on a delicate balance of trust. Ideally, there is mutual respect between the two parties which results in better health outcomes and patient-centered decision making. However, this trust can be broken due to imbalanced power dynamics.
- Providers can take advantage of their power-heavy position to make decisions for the patient or their family without discussing decisions at length beforehand
- Lack of shared decision making can result in limited treatment as well as patient safety issues
If the general population has a hard time speaking up in a patient-provider relationship, it can only be more difficult for disabled individuals, a group that has been systematically oppressed and degraded as being “less than.” Patients who are attentively listened to, respected, and thoroughly educated by their provider would be more likely to feel comfortable and open to self-advocating their opinions and values.
Minimizing the Power Distance
Although providers inherently have greater power from years of training, they can reduce power imbalance through thorough patient education and communicating with a patient in ways they can understand.
Providers should not assume that it is not worth it/necessary to provide thorough patient education or discussion of issues because of someone’s disability. Providers can create a safe space, free of preconceived notions and assumptions, so patients feel valued and comfortable in contributing their opinions. Both parties bring crucial viewpoints: the provider - technical expertise and the patient -personal goals and needs.
Although providers inherently have greater power from years of training, they can reduce power imbalance through thorough patient education and communicating with a patient in ways they can understand.
Providers should not assume that it is not worth it/necessary to provide thorough patient education or discussion of issues because of someone’s disability. Providers can create a safe space, free of preconceived notions and assumptions, so patients feel valued and comfortable in contributing their opinions. Both parties bring crucial viewpoints: the provider - technical expertise and the patient -personal goals and needs.
Sources
(1) Liu, S. Y., & Clark, M. A. (2008). Breast and Cervical Cancer Screening Practices among Disabled Women Aged 40–75: Does Quality of the Experience Matter? Journal of Women’s Health, 17(8), 1321–1329. https://doi.org/10.1089/jwh.2007.0591
(2) Bell, S. K., Roche, S. D., Mueller, A., Dente, E., O’Reilly, K., Lee, B. S., Sands, K., Talmor, D., & Brown, S. M. (2018). Speaking up about care concerns in the ICU: Patient and family experiences, attitudes and perceived barriers. BMJ Quality & Safety, 27(11), 928–936. https://doi.org/10.1136/bmjqs-2017-007525
(2) Bell, S. K., Roche, S. D., Mueller, A., Dente, E., O’Reilly, K., Lee, B. S., Sands, K., Talmor, D., & Brown, S. M. (2018). Speaking up about care concerns in the ICU: Patient and family experiences, attitudes and perceived barriers. BMJ Quality & Safety, 27(11), 928–936. https://doi.org/10.1136/bmjqs-2017-007525
