Hi, and welcome to my blog! I'm Susan E. Mazer -- a knowledge expert and thought leader on how the environment of care impacts the patient experience. Topics I write about include safety, satisfaction, hospital noise, nursing, care at the bedside, and much more. Subscribe below to get email notices so you won't miss any great content.
September 22, 2017
This month, Mayo Clinic’s medical education journal published an article by Texas A&M Professor Leonard L. Berry and others about “Hostage Bargaining Syndrome” (HBS).
HBS is what happens when the power differential between physicians and patients is perceived to be a barrier to shared decision-making.
The only difference between patients and their caregivers – whether physicians, nurses, or family – is acuity. Equality is experienced in our common humanity and can be evidenced in shared knowledge, mutual respect, and trust.
Fear and confusion plague the patient experience if there is no path for relief from HBS.
According to Berry and his colleagues, one of the risks for patients experiencing HBS is withholding of critical information about themselves that are needed to accurately inform medical decisions. Patients may under-report symptoms (pain, nausea, anxiety), or a detail about their personal or family history in order to protect themselves.
The U.S. healthcare system has tremendous power over patients. Often it decides whether to see or not see a patient, how quickly to provide care, and sometimes delivers better care to those patients who can pay. The assumption that clinicians are smarter and know more than the patient is, in part, what makes the healthcare system intimidating.
Add to that the overwhelming fear that comes with any healthcare crisis.
Learned-helplessness hides inside HBS. It shows itself in extreme passivity and a lack of hope because patients no longer feel that they can affect their own condition. From at 2001 article in Health Affairs, “Clinical outcomes are best improved when the patient is both ‘informed and activated.'”
Berry and his colleagues offer communication techniques for “freeing the hostages” and engaging in shared decision-making, but do not mention the design of the physical environment itself. Creating an environment that supports and expresses compassion and empathy, facilitates personal and authentic communication, and offers hope is essential to reduce the risks associated with unempowered patients.
Here are seven things you can do to help facilitate shared decision-making, some of which are about the physical environment:
What else would you add to this list?
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