education

Patient Safety

Concern for patient safety is a major concern in the U.S. today. But physical safety is not the topic of this essay.

I am referring to the degree of psychological safety patients feel when they are with us. The opportunity to talk about our experience without feeling the need to shape our narrative to avoid disapproval is rare. Self-censorship becomes second nature to us and differs according to the audience with whom we are communicating.

Do you have a close friend with whom you can be completely candid, someone with whom you can totally let down your defenses? Such friendships are rare and we treasure them. Our patients need such treasures more than most because diabetes comes with so many dos or don’ts that virtually every aspect of their lives can be scrutinized and judged by others.

Feeling completely safe allows our patients to talk about their experience unfettered by the need to win our approval and/or avoid our disapproval. It’s a dialogue in which there is no possibility of shoulds or shouldn’ts arising. What’s truly valuable about our patients feeling completely safe with us is not what we learn about them. It’s what they learn about themselves by giving voice to their experience uninhibited by self-censorship. Such opportunities are rare and often lead to insights, sometimes to profoundly important insights.

It’s very easy to convince ourselves that we offer that degree of psychological safety when in fact we don’t. We need to ask ourselves “As we listen to our patients do we often end-up believing that we know what they should (or shouldn’t) do?” Do we try to work unasked for guidance into the conversation? After all, we can say to ourselves “I’m doing it for them.” When we listen to our patients do we feel compassion, respect, and acceptance? Or do we sometimes try to appear compassionate, respectful, and accepting when if fact what we are feeling is disapproving, annoyed or judgmental?

Do we believe we can fool our patients about how we really feel? Most times the answer is no. Human beings are equipped with a sophisticated, complex and largely unconscious system for detecting the true feelings and intentions of other people. For hundreds of thousands of years human survival has depended on our ability to discern what others are really feeling. When we make those discernments today we often say things like “I just had a sense”, “I had a gut feeling” or “something didn’t ring true.” In those situations we are making detections but are largely unaware of the perceptions that trigger such reactions in us. (e.g. body language, tone of voice, facial expressions especially eye movements). Our patients are also equipped with that same ability.

Our personal and professional growth is enhanced when we are honest with our selves. When we speak to our patients we can ask ourselves “Whose needs am I trying to meet?” “Am I (even subtly) trying to get the patient to see thing my way?” “Do I truly respect their right to make decisions with which I disagree?”

Our job is to create relationships in which our patients feel completely safe, in other words we need to learn how to love them.
Bob Anderson
education > teaching the educator