What your patient's family is telling you can make a difference. Are you listening?

We who are fortunate to work in healthcare study and train for years to develop the knowledge, expertise and resulting confidence to make decisions that are in the best interests for our patients. It's a tried and true process; families rely on us to know what to do.

Yet as much as our training and knowledge are important in guiding our decisions, these alone will not result in excellent care that meets each patient's goals and that aligns with their values. Patients, their loved ones and other members of the care team also have important information to contribute. Unfortunately, we physicians don't always see these other perspectives. 

The bottom line is that our confidence that we're doing the right thing should not crowd out voices from the patient and their family in the conversation. A parent or spouse will see things in their loved one, for example, that a short check during rounds may never reveal. Conversations with families that are just us speaking — without the important complement of listening to what they're saying about their loved one — really listening — will never get us to where we all want to be.

Families have many important things to teach us — consider it their experiential wisdom — especially important in patients with chronic or complex conditions. In fact, our ability to honor this wisdom is essential for safe, effective care.

How do we build this more fully into our daily work? It won't be easy. The word epistemology refers to the theory of knowledge — in simple terms, how we know what we know or the underlying wisdom of what we value as wisdom. 

The epistemology of healthcare is rather limited. Too often, healthcare views wisdom as only book knowledge and physician experience, only available through a strict hierarchy. The most senior physician is viewed as wiser than the junior physician, who is wiser than the resident, who is wiser than the medical student.

However, an equally important domain is experiential wisdom. This is guided by the time spent with the disease or the patient. As such, it abounds in spouses, loved ones, patients themselves, nurses, physicians and other caregivers who spend extended periods of time with the patient every day — an extra source of insight along with the book knowledge they bring to the table. 

In fact, members of the care team other than the physician often spend more time with the patient than the physician is able to and can offer a unique perspective. These people have ultra-sensitive radar for spotting subtle harbingers of risk or harm. When something seems off with their loved one, they know something's different. 

They may not be able to tell you the diagnosis or the disease. They don't need to. What they sense is something's wrong, and we will provide better care when we seek out and honor this wisdom.

At my institution, we're training all our physicians and staff to be more attuned to these moments and to more fully respect the experiential wisdom expressed by the patient's family and loved ones — and to also listen more closely to nurses' and all caregivers' voices. We developed and deployed a systemwide initiative called "Pause, Please." If any clinician says this phrase, the care team stops, the person who called the pause expresses their concerns and the group discusses the path forward. 

For example, if a nurse says "Pause, please, I have a question about what we are about to do," the only acceptable response is to immediately stop what we're doing and discuss their concern for the patient. Anyone can call a pause. To ensure all honor the new process, we encourage and reward those who do speak up and accordingly, review events when the pause is not honored. "Pause, Please" is a powerful way to build mutual respect and an even more positive culture of Zero Harm.

We in healthcare are at a bit of a crossroads, and not necessarily in a good way. Although trust in our profession spiked at the beginning of the COVID-19 pandemic amid the heroic efforts of caregivers across the country, the ripple effects of the pandemic left a large segment of the population feeling unsettled. 

In 2020, for example, Gallup found that 51% of Americans had a positive view of healthcare, with 31% saying their view was negative. Fast-forward to 2023, where the numbers are reversed: Forty-nine percent have a negative view of healthcare, with only 35% having a positive view.

These poll findings are not good news — but they're not insurmountable either, and they present an opportunity. By making a more deliberate, systematic effort to listen to the experiential wisdom of patient families — taking the time to build it into our care paths and workflows — we can take a large step toward restoring the vital trust in healthcare that patients need to live healthy lives. 

Healthcare will provide much more compassionate, safer care when we honor experiential wisdom of all.

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