Meeting patients where they are
During interviews, doctors and nurses alike frequently used the expression ‘meeting patients where they are’. Knowing about patients’ social circumstances prior to this meeting was not considered useful or relevant to communicating:
“I don´t know what people have been doing [jobwise].I do not know about their education. I hardly care about it. I treat the patients for what they come for and then we take it from there. I meet the patient, where the patient is.” (D2:1)
Meeting patients ‘where they are’ also meant being open to what might happen in the situation:
“I also think it is a problem if you look through the diagnostic list and decide how to talk with the patient instead of being open to what happens along the way” (D1:1).
HPs explained that other existential factors such as responses to crises could prove significant and were independent of a patient’s social background:
“You may have information about the patient in advance, but you must meet the person where the person is. Many patients here are in crisis and then you must, of course, take stock of the situation”(D5:1).
‘Taking stock of the situation’ meant forming an overall impression of the patient here and now, which might mean judging that the patient was emotionally overwhelmed and adjusting information accordingly.
HPs were frequently surprised by patient reactions and outcomes. A patient could appear well-educated, well-off, physically strong and in every way prepared to start treatment. And then, they could suddenly break down mentally, and prove to have family or alcohol problems. Conversely, there were patients with little education and poor language, smelling of smoke, who turned out determined and adherent throughout their treatment, successfully supported by close family members. This element of surprise meant that doctors and nurse did not find prior knowledge of the patients’ social circumstances essential:
“It is a nice information to have where people live and what they do, but you can´t use it, if you haven’t met the man” (D1:3).
HPs felt it important not to prejudge patients by accessing information about their social circumstances. They explained that they wanted to address the patient as an individual, not as a category:
”I mostly think of the patient as an individual who enters the door, and then I have to find out where this particular person is, and what I should contribute, and then I … try to see the patient as an individual instead of a social category” (N3:2).
HPs prioritized their own observations, concerned that categorization might lead to unequal treatment:
“Actually, I don´t think that patients’ social position means so much. Because I think we should meet the patients equally” (N4:3).
This meant ‘taking stock’, ‘meeting patients where they were’ and avoiding social stereotyping.