Information Asymmetry of patients From New England Journal's Catalysy

[Annette McKinnon]

From SPM and Dave de Bronkart

New England Journal's "Catalyst" opinion feature:

https://catalyst.nejm.org/information-asymmetry-untapped-patient /

Danny Sands often uses this "information asymmetry" item in his speeches, pointing out that it's a term that came from The Art of War (the ancient Chinese book on military strategy) and is now often used in Silicon Valley.

The military concept is easy to imagine; just think of an ambush: one party knows what's about to happen, and the other one is at a BIG disadvantage. ​​

The article, though, doesn't bluntly address the strategic power imbalance that some use intentionally to gain an unfair advantage - it merely talks about how such imbalance can hold back progress. (Danny talks about it (to physicians) as perhaps being an "unfair burden" to make the physician responsible for all knowledge .... I always figure that's a way of sweet-talking them into sharing power.)

The word "patient" appears 80 times on the essay's page, and the three summary boxes are explicit in how they see patient POV as contributing to better care, and three levels:

• STRATEGIC LEVEL: SYSTEMS AND POLICY

• CLINICAL LEVEL: CARE DELIVERY AND DECISION-MAKING

• TACTICAL LEVEL: PROCESS AND PRACTICE

[Samira Chandani]

Very interesting article Annette. Thanks for sharing. Always listen to the patient

[Elizabeth Nadeau]

Hi Annette; this is a good read, thanks for the post. As a mediator, we use this language all the time so I am delighted to hear it finally coming from the mouths of clinicians. I absolutely agree there is a fundamental imbalance of power between the clinician and the patient. In my experience with my own healthcare journey, some, if not the majority of clinicians will take advantage of this imbalance to the detriment of the patient.

In my work as a mediator, I assist clients with interest based facilitated negotiations at the end of a marital relationship. I help them make plans for children in the midst of their own conflict. My assumption starting out is that both parents are competent and capable of participating in the discussion on an equal basis. A power imbalance between parents can impair the quality of the negotiation, and it's my job is to try to re-balance the power dynamic to ensure the negotiation is fair. You can't get a fair outcome if the process is fundamentally flawed.

I am trying to develop a more collaborative communication model that will assist patients in re-balancing the power dynamic within their healthcare team. I think the quality of the relationship between patients and physicians is critical to a better quality health outcome.