Patient stories revealing the benefits of reflexivity

For Care Opinion Australia’s end-of-year celebration, each week we will be releasing a blog about a story that personally had an impact on us. These stories will be our gift to you.

For our first week, I have chosen a story which had a particularly lasting effect on me titled, ‘Negative experience turned positive’. This story reinforces the benefits that reflexivity can have on clinical practice. If we encourage a culture of reflexivity in hospital and care settings, I believe healthcare will be more culturally and psychologically safer for all involved. I encourage you to read the story before reading the blog.

It is not uncommon to read stories on Care Opinion where a clinician’s good intentions are received poorly or misunderstood by their patient. In these situations, both clinician and patient were present for the same event and yet both have two juxtaposed interpretations of what occurred.

So, why does this happen?

In philosophy, these differing versions can be discussed through the lens of phenomenology: a study that aims to examine how reality is based upon individual perceptions and subjective experiences rather than on any objective truth [1]. Our values, missions and personalities are all shaped by our phenomenological experience of the world and this influences how we act towards others and react to events.

Healthcare is no exception. 

This subjective reality has direct implications for health and medical education as our experiences in life precisely impact how we respond and behave in clinical settings. A patient’s treatment and care can be affected by a clinician’s unconscious bias or ignorance of certain life events; a seemingly harmless comment can trigger a person’s trauma, a joke could be taken the wrong way or even a mere glance during admission can be misrepresented as being cold or rude.

In an attempt to somewhat remedy this gap, there has been a relatively recent movement seeking to increase the usage of reflexivity in healthcare and broaden the relationality that exists within the doctor-patient dynamic [2]. Reflexivity, at its core, can be understood as a skill that allows clinicians to introspectively reflect on how their phenomenological and subjective experiences affect the way they treat and care for patients [3]. So too, can reflexivity help clinicians understand how their actions can be perceived and received so differently from one patient to the other. For this reason, reflexivity in healthcare is crucial for producing culturally safe, person-centred and trauma-informed care.

The benefit of reflexivity for patient and doctor interactions is highlighted in a recently published story on Care Opinion titled, ‘Negative experience turned positive’. Though the author’s experience was initially negative, their story results in an ultimately positive and uplifting message due to the actions of the doctors and the nurse. The two doctors recognised the need for the nurse to intervene, listened carefully to how the patient perceived the situation and finally thanked the patient for this feedback. By listening to the patient’s recollection of how they perceived their care, and understanding the complexities of the patient’s lived experience, the two doctors were practising reflexivity. 

Patient feedback, particularly through story-telling, is fundamentally reflective. These stories enhance our understanding of the ever-present subjectivity that exists within the realm of healthcare experiences and challenge us to consider the impact that a person’s unique life experiences can have upon their actions and reactions to clinical events. This endeavour is not in vain. Through practising reflexivity in healthcare, awareness and psychological safety will be further embedded in clinical environments. It is through this act of reflexivity that an interdisciplinary and interactive healthcare culture is embodied, one where both clinician and patient can achieve better outcomes together.

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[1] Dawson, J., Laccos-Barrett, K., Hammond, C., & Rumbold, A. (2022). Reflexive Practice as an Approach to Improve Healthcare Delivery for Indigenous Peoples: A Systematic Critical Synthesis and Exploration of the Cultural Safety Education Literature. International Journal of Environmental Research and Public Health 19(11), 1-22. Sourced from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9180854/

[2] English, W., Gott, M., & Robinson, J. (2022). Being reflexive in research and clinical practice: a practical example. Nurse Researcher 30(2), 30-35. Sourced from: https://pubmed.ncbi.nlm.nih.gov/35642591/ 

[3] Geiser, E., Schilter, L. V., Carrier, J.-M., Clair, C., & Schwarz, J. (2022). Reflexivity as a tool for medical students to identify and address gender bias in clinical practice: A qualitative study. Patient Education and Counseling 105(12), 3521-3528. sourced from: https://pubmed.ncbi.nlm.nih.gov/36075808/