You should feel safe, not judged, at a doctor’s visit | Expert Opinion
In medicine, a psychologically safe office or exam room may help patients feel more comfortable discussing emotionally sensitive concerns. It may also improve the likelihood of scheduled follow-up.
A friend and colleague recently told me that he can feel anxious about going to see his doctor for follow-up care if he has not accomplished the health goals discussed at his last visit.
When I asked why, he said he worried that he would be labeled “nonadherent” or scolded for being unprepared. He did not want to waste his doctor’s time.
I was surprised, since many of my own patients come in for visits without completing every goal we set out. I may not have communicated the plan clearly, and sometimes, as the saying goes, life gets in the way.
Then I began to wonder about patients who cancel appointments, miss follow-up visits, or never schedule them at all. Could some be avoiding care because they fear being judged for not meeting expectations?
As physicians, we often emphasize treatment plans and health goals. Less often do we consider whether patients feel safe admitting when they have struggled to follow them.
I would never scold a patient if they did not complete everything on the to-do list. At the same time, I don’t think I have ever directly said that I want to be sure they come back for follow-up regardless. I realized that I could address this with phrasing like:
I trust you will try your best to follow our plan. But whether you are able to get these things done or not, I still want to see you back in a few months.
Astute problem-solving, empathy, compassion, and clear communication are qualities clinicians aspire to in our professional roles. Equally important, though less emphasized, is creating a psychologically safe environment. This means ensuring patients can speak honestly without feeling at risk of being judged.
Psychological safety was originally studied in workplace teams, based on the work of Harvard researcher Amy Edmondson. To reach high performance, Edmondson found team members need to feel comfortable taking risks, admitting mistakes without fear of shaming or reprisal.
The principles of psychological safety apply to many settings. Planet Fitness, for example, posts signs on the walls and equipment declaring “Judgement Free Zone” and “No Gymtimidation” in an effort to make members feel welcome regardless of their level of fitness.
In medicine, a psychologically safe office or exam room may help patients feel more comfortable being vulnerable and discussing more emotionally sensitive concerns. It may also improve the likelihood of scheduled follow-up.
So what did I tell my friend-colleague? I suggested that he think about the source of his follow up worries. Some of this may require self-exploration, but there may also be areas where his own medical practice could do a better job at creating a psychologically safe, nonjudgmental environment that encourages follow-up.
Patients should know that a missed goal is not a failed appointment. In health, as in life, progress is rarely linear. In fact, the times when things have not gone according to plan are often the times when medical follow-up matters most. Clinicians should make that message clear.
Jeffrey Millstein is an internist and regional medical director for Penn Primary and Specialty Care.
