Arrogance, condescension and indifference in communication with patients

Glòria Galvez

In traditional society, men have had an authority role and women a secondary and subordinate role. As a result of this form of behaviour comes the term mansplaining, a combination of the words man and explaining. The term appears for the first time in a text by Rebecca Solnit “Men explain things to me” to define the habit of some men to express their opinion with authority, condescension and a paternalistic tone on all kinds of subjects, even if their experience is little or non existent.

John Launer, in the article published in the Postgraduate Medical Journal, talks about medical condescension or "docsplaining" that, like mansplaining, has to do with paternalistic and condescending behaviour. In this case, it’s the professionals –men and women– who, to maintain control of the conversation with patients, address them with a certain arrogance exercised from parental ambiguity.

The term has been spread on twitter tagged with the hashtag #docsplaining, so that users of the social network share stories and comments that professionals have addressed to patients in a paternalistic and condescending tone, without being aware of the negative effect they produce on their emotional state. Some examples have to do with the attitude of contempt towards the searches that patients carry out on the web related to their health problem or with how professionals relate their pain with phrases like it will not be so bad.

There are other forms of condescension such as the excessive confidence with which we tend to minimize the concern that patients feel about certain symptoms, (I wouldn’t be worried about that), something that in addition to not reassuring them makes them feel misunderstood. It can also occur when using euphemisms of the type: it will only be a little prick, to mask the pain that they will feel with an invasive procedure, which even if said with good intentions, usually fails when the patient discovers that reality doesn’t correspond to the good expectations.

On other occasions, when we give bad news, we show an attitude of certain indifference using excessive medical terminology or providing data from studies and research without thinking that the emotional state of the patient at that moment doesn’t allow him to assimilate this type of information. Or we justify involuntary admissions to patients with psychiatric disorders because we keep them safe.

Docsplaining is usually directed at patients, but there is another type of docsplaining, directed at colleagues from another professional group. In this case, we overestimate our knowledge because we believe we are experts in everything and we explain with a certain point of arrogance. As Franz Ingelfinger said in the NEJM article Arrogance, the arrogance of ignorance can be as devastating as the arrogance of the expert.

Shared decision making is a good way to avoid condescension since, by striving to put ourselves in the patient's shoes and understand their situation, we adapt our explanations to their needs and emotional state. On the contrary, if we try to show that we identify and understand their emotions by automatically using phrases learned in communication courses, this will make us seem distant, thoughtless and automatons.

Once familiar with the concept of “docsplaining”, we recognize this attitude in ourselves and our colleagues. Maybe, as Launer says, we need more patients to make us blush because of the way we talk to them, or maybe we need to listen to ourselves because if we heard ourselves we would find it laughable.