Are you a good patient? Yes, you’re health professionals, and you’re also patients. The concept of “a good patient” has been around for decades. Today we’re going to look into it with a real patient story, some research and concrete things you can do as a professional to help keep the good patient from getting in the way of good care.
Hi, everybody. This is 10 Minutes to Better Patient Communication from Health Communication Partners. Since 2017, we’ve been giving you inspiration and strategies to improve engagement, experience, and satisfaction. I’m Dr. Anne Marie Liebel, a researcher, consultant, and educator specializing in communication and education. This podcast makes space to dig into what it’s easy to take for granted about communication in our professional lives, especially in healthcare and public health, but increasingly across sectors because communication touches everything. We’re here to learn and get inspired, but most importantly, make the difference we got into our jobs to make.
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Over the last couple weeks, three separate people in three separate conversations used the same phrase, a good patient. When that happens, I like to stop and pay attention. Two were health professionals talking about family members as “good patients.” Well, one of them was one of my best friends. She called me to talk about the fact that she had just had her first colonoscopy. And hey, if you’re over 45 and you haven’t had yours yet, talk to your doctor. But then she starts talking about being a good patient. And I knew, I was like, all right, I’ve got to pay attention to this. She said I could share her story with you. Thanks, girl!
What she told me was briefly, like the visit, everything from the moment she walked in, went almost too quickly for her to get oriented to it. She hadn’t gotten to sit down before they called her back. She said, “They went through pre-op questions kind of quickly, while at the same time, someone else is trying to take my blood pressure.” These multiple layers of quick activity in an unfamiliar environment threw her off.
She told me she had to kind of talk herself down. She said, “Internally, I’m like, ‘okay, I’m going to be a good patient.’ And I think I am a good patient.” I asked her what she meant. She said, “I’m the kind of person who noticed, ‘oh, I feel like this doctor is upset with me,’ or I don’t want to make the doctor feel bad.”
What’s going on here? You know, in the show, I don’t sit around wondering what to talk about. Episodes are based on problems or issues raised by real people in the field that have to do with communication. But Anne Marie, you might say, is the good patient a problem? I’m interested in the social and institutional pressures toward being seen as a good patient. And how it might get in the way in communication. So my search for good patient studies was not a straight line because mainly PubMed doesn’t index that way. I looked for “good patient” and got 7,000 hits. So I started sifting through and I eventually got there.
It was interesting to me to see how many studies were based implicitly, maybe explicitly, on the assumption that the problem, if there is one, is in the patient. That patients are somehow performing perhaps an inauthentic role. Or they’re being deviant in some way. I saw the phrase “withholding information” a lot. And that’s interesting to me, because it gives the sense that they’re doing something wrong, that they are holding back something that they ought to be sharing by some unwritten rules.
I see patients as active participants, people who are constructing a response to a situation or a set of conditions, in a relationship with an unequal power dynamic. Yep. So a patient withholding information is not the same as their conforming to a social pressure or actively working to be seen in a certain way.
So I did find some “good patient” studies that I want to share. The oldest direct line went to Talcott Parson’s “sick role” concept in his 1951 book, The Social System. So this is a theory, the first one that’s broadly known to frame patienthood as a social role. And a social role with rights and obligations attached to it. Specifically, the patient role, the “sick role” involves a duty to want to get well and to cooperate with treatment. So we have an indication of what some of the earliest conceptions of the “good patient” are.
The next, I think, line that was directly to the “good patient” came from sociologist Irving Goffman’s 1959 study, The Presentation of Self in Everyday Life. And of course, links to all of these in the show notes. The most direct historical piece was Judith Lorber’s 1975 study in New York, “Good Patients and Problem Patients, Conformity and Deviance in a General Hospital.”
Now, this study found “previous research had suggested that medical personnel encouraged trust, cooperation, uncomplainingness, and undemandingness in patients. But Not all patients subscribe to these norms to the same degree.” And Lorber calls these “good patient norms.” She cites Goffman’s book right up front. It’s a fascinating read. I really do recommend it if you’ve got a chance. It’s out there on JSTOR, I think a couple other places you might be able to find a copy because it’s kind of old. But I don’t know how much has changed. The review of literature is pretty fascinating to read. The “deviance” in the title is from the point of view of the staff.
I found some definitions of a good patient. One from a 2009 study in the UK that says, “the good patient persona is the sum of particular aspects such as compliance, sycophancy, and positive coping being enacted to varying degrees within the situated context of the interaction.”
A 2015 study out of Zimbabwe found that most of the “good patient” research actually only surveyed health professionals. So we’re getting health professionals idea of what the “good patient” is and not the patient’s idea of what the good patient is. So for their study, they included both. Their definition is this: “Characteristics of a good patient include obedience, patience, politeness, listening, enthusiasm for treatment, intelligence, physical cleanliness, honesty, gratitude, and lifestyle adaptations (such as taking pills correctly and coming to the clinic when told).” This study points out, yes, most of these characteristics are things that will increase positive health outcomes. Oh, and they also help interactions at the hospital go smoothly. Don’t want to introduce friction into the system.
Now, there’s a separate but related literature on how being labeled “difficult” changes the care a patient receives, which is the flip side of the “good patient” pressure, like not wanting to seem difficult or ungrateful, and so being punished in some way.
Now, I’m interested in what all of this has to do with communication. And fortunately, these studies, most of them took patient communication as being one of the main ways that people enact the “good patient” role. Most of them, I think, outright say that the good patient position costs both the patient and the clinician.
Good patient behavior is often working against the clinician’s goal of getting an accurate picture. So you’ve got missed clinical information, maybe false agreement or an assumption of alignment, decisions that aren’t truly shared, follow through that’s more difficult than it needs to be. Because a patient who’s trying to be a good patient might be absorbing distress rather than asking for what they need, rather than clarifying something, rather than pushing back.
Patients may suppress the questions they most need answered, because asking feels like being difficult, taking up too much time, seeming ungrateful. Patients might worry that their questions seem confrontational, too direct, or otherwise uncomfortable for them. Or the clinician, or both.
Patients also read time pressure. You know this. The visit compression to 15 minutes or whatever it is, is a structural factor making this worse, because patients sense the time pressure and self-edit before they even open their mouth. Like, oh, I’m not going to ask. I could just leave and ask AI and not risk the relationship.
Now, I promised I would end with practical things you could do. And here are three. Three things you can do right now and with your next patient. Everyone hearing this has also sat in a waiting room, filled out an intake form, and when talking to a provider, decided in the moment how you were going to respond. What you were going to say and not say. Remember the last time you did this. What trade-offs or pressures do you think you might have been responding to in that moment that made you say what you did, and not say what you didn’t?
Secondly, recall your patients are also doing similar mental calculus when they’re communicating with you. Also remember, too, the momentum of the visit, the speed of it all, the workflow, the patient flow that carries you along like a speeding river like they did to my friend. Another systemic pressure to behave in a certain way.
And finally, don’t forget to give your patients permission to not be a good patient. Really take a moment, a beat during the visit, to let them surface those hard or uncomfortable questions. Literal permission not to be a good patient and ask or say what they need to. You can take it! Rather than relying on the patient bringing something up without your asking. And don’t do the, “any questions?” thing at the end. You know most people don’t answer that. You don’t answer that probably. Why? Because of social pressure not to.
So this is really about recognizing the larger social and systemic level pressures that we all respond to, that in some cases can get in the way of the patient-provider relationship. The reminder here is: reduce that pressure by lowering the cost of speaking up. One way to do that is to give others, and hey, yourself, permission not to be a good patient. This has been 10 Minutes to Better Patient Communication from Health Communication Partners. Audio engineering and music from Joe Liebel. Additional music from Alexis Rounds.
Thanks for listening to 10 Minutes to Better Patient Communication from Health Communication Partners, LLC. Find us at healthcommunicationpartners.com.
