Patients commonly feel themselves to be in the weaker position in a medical interview. This may be exacerbated by their own problems or by their clinicians. The aim of shared care is to overcome this inequality.
Anxiety and its consequences
Most patients are anxious to some extent and often try to hide it. Anxiety can make patients seem to regress in behavior, mental power and memory. Free-floating anxiety may cause ideas which are worse than reality and contribute to complex misconceptions.
Anxiety and medical ignorance commonly create misconceptions in patient’s minds about their illnesses which in turn profoundly affect their symptoms and the ability to recover. Such misconceptions need detecting and uprooting, without which correct information will not register. Simple reassurance will not supplant a misconception.
Apart from friends, family and the media, patients get varied information from many different healthcare professionals. Clinicians seldom record what they tell patients. Conflicting information can lie long undetected whilst it contributes to misconceptions.
Patients, like most of us who are provided with numerous new and alarming facts, tend to forget all but a few, unless care is taken to aid their memory. This is compounded if they are told information in words they do not understand. However, if information is given carefully, 70-80% of the facts will be remembered by a patient after 6 weeks, or even indefinitely. An exception is evident in well-informed surgical patients who often forget most of what they were told within weeks of their operation.
Disinclination to disclose their concerns
Patients may not disclose all their concerns if they feel nothing can be done, or they are wasting the doctors’ time, or fear being thought neurotic with non-physical problems. They are less likely to be forthcoming if their first questions are blocked or answered incomprehensibly, if they fear their effective treatment may be withdrawn, if they are distracted or distressed, or if they do not like or
Impaired faculties of communication
Patients with impaired hearing or speech or vision or mental function or whose clinician does not speak their language all experience substandard healthcare as a direct result of their inability to communicate. One in five medical patients has psychiatric illnesses, diagnosed or otherwise, which may affect their ability or inclination to communicate.