WARNING: Mistaken Assumptions Can Be Hazardous 
to Your Patients' Health

WARNING: Mistaken Assumptions Can Be Hazardous 
to Your Patients’ Health

Topics

Civility and Communications Patient Safety

When you drive on a busy road, you assume the cars going the other way will stay on their side of the line. It’s a reasonable assumption that lets you focus on the road ahead. That’s what assumptions do. They let you ignore the obvious so you can concentrate on what’s important.

But what if you have unknowingly turned the wrong way down a one-way street? Suddenly, your safe assumption about the other cars is anything but safe. It leads you to ignore precisely what’s most important. The sooner you realize why everyone is honking and shouting at you, the better. 

Unfortunately, you don’t always get such obvious warnings. When it comes to doctor-patient communication, there are four assumptions to watch out for.

1. You assume you know what your patient is going to say.

There’s a room full of patients waiting to be seen, paperwork piling up, and bookkeepers urging you to “increase your efficiency” (i.e., see more people in less time). When a patient starts describing the symptoms of a virus that’s going around, you assume you can dispense with the full litany of complaints and start offering your diagnosis. 

Such interruptions have been common for some time. A 1999 study found that on average, physicians waited just 23 seconds before interrupting patients who were explaining why they had come in. When researchers conducted a similar study in 2018, they found that patients were interrupted after just 11 seconds.

Both studies found that the interruptions saved little if any time. In the earlier research, the patients who were allowed to finish what they were saying took just six seconds longer on average than those who were interrupted. The 2018 study found that uninterrupted patients took between 3 and 19 seconds to tell their stories, a median of just six seconds.

Take away:

Give your patients time to fully describe their concerns before you start talking. The few extra seconds will cost you little in the long run and yield big returns in terms of information and patient trust.

2. You assume a patient conforms to a stereotype.

We make assumptions about people all the time. That person seems friendly. That one, well it’s probably best to cross the street. If we make an assumption based on an offensive stereotype, someone is likely to point it out. Other biased assumptions often sneak in under the radar.

When you ask your 80-year old patient how the new medication is working, he shrugs apologetically. He forgot to fill the prescription. It’s not surprising, you tell yourself. Older people tend to have memory problems. You tell your patient not to worry about it, but suggest he ask a family member to accompany him in the future. 

The patient’s son calls a few days later. It’s not a memory problem, he explains. His father grew fearful after reading about the medication online. Not wanting to offend you, he avoided an uncomfortable discussion by saying he just forgot.

Take away:

Ask yourself if you would react the same way with a different patient. If the patient in the example had been a young college student, you would probably have spent more time asking about the forgotten prescription.  

3. You assume your cultural expectations are universal.  

One patient is chronically late. Another smiles and laughs throughout a visit.  A third stares at the floor, refusing to make eye contact. If you were raised and trained in North America, you are likely to think these patients are, respectively, rude, happy, and ashamed. 

But according to the Cleveland Clinic’s Diversity Toolkit, you may be misinterpreting your patients’ behavior. The Toolkit is a resource for clinicians treating patients from any of 36 different cultures. It includes information about a wide variety of regions, religions, and sexual orientations. 

According to the Toolkit:

• If the first patient is from an African, Arab or Latin American culture, they probably have a more fluid concept of time and are simply more relaxed than you about punctuality. 
• Your laughing patient may be happy. But if they are Japanese, their laughter may signal confusion or embarrassment. 
• And in many cultures, avoiding eye contact is considered a sign of respect.

Take away:

When a patient’s behavior concerns you, find out more about their cultural expectations—where they grew up, how long they’ve lived in the area, etc.

4. You assume you are objective.

Believing that emotion is the enemy of rational thought, many clinicians try to banish personal feelings from their thinking. But try as you might, you cannot simply switch off your subjective emotions whenever you want to. Nor should you. Acknowledging your feelings allows you to explore how they might be affecting your thinking.

Did you avoid tackling a painful topic because a patient reminded you of a frail parent? Did you spend more time than you needed to with a patient because you found them attractive? Or dismiss another’s concerns prematurely because you found them unpleasant? 

Asking questions like these is not a failure of objectivity. Quite the opposite: it’s a crucial way of ensuring you are being objective. You may think you have protected your reasoning from your emotions by suppressing your feelings. In fact, denying your emotions simply blinds you to the ways in which they may be influencing you. It also deprives you of an important resource in your interactions with patients.

Take away:

The only way to ensure your objectivity is to question it. Ask yourself how your feelings about a patient might be coloring your thinking. And don’t ignore other emotions. Lingering anger after an argument with a colleague can also affect your thinking about a patient’s diagnosis, as can the afterglow of a recent promotion. 

You cannot possibly eliminate all your assumptions. Nor should you. If you continually worried that cars heading in the other direction might be a menace, you wouldn’t be able to drive anywhere. But the more you know about assumptions that commonly cause problems, the better prepared you are to recognize when.