Objectivity in Patient Care

Maintaining your objectivity as a health care professional is imperative for proper patient care and is usually not difficult in most cases. However, there are certain situations where it becomes a real challenge.

Trying to take care of family members is recognized as one of the more obvious situations where it is very difficult to maintain a proper clinical perspective, and we usually try to avoid being the main providers when loved ones are involved.

However, sometimes the lack of objectivity may not be so evident.

In one such case, the son of an elderly gentleman became outraged because there was a two-day delay in getting back a blood test on his father even though that particular test was not really critical to the care of the patient. This served as an opportunity for the son to ventilate several other details where it was perceived that we had fallen short on our ability to provide the “highly attentive care” slogan that we were using to promote our practice. These points were well taken and apologies and promises to improve were made. However, from that point on, I noticed that I was having a little difficulty in being objective when making decisions about that patient. For example, I found myself making decisions not necessarily for the patient’s welfare but rather to do whatever I could to avoid the wrath of the son. Sometimes, that coincided what was right for the patient but sometimes it did not. It was easier to do what the son thought we should do - like, for example, give an antibiotic when it wasn’t required.

Whether we want to be or not, many of us are influenced by these interactions in ways that we may not readily recognize. Some of these influences may be very subtle. For instance, if the patient says that her mother died as a result of someone’s “neglect” in evaluating leg swelling as a potential sign of thromboembolism, you can bet that we will be much more sensitive to this than we might be otherwise if the patient now says her leg feels swollen even if it is not swollen by examination.

Indeed, it is sometimes difficult to be completely objective in this world where so many people are “knowledgable” about medicine and health care. Our clinical judgement may be slanted one way or another by what our patients say or about how opinionated they might be about certain aspects of their care.

Our clinical perspective may be affected also by representatives of pharmaceutical companies who want us to prescribe their particular brand of medication, even though another brand or a generic may be just as effective and less expensive.

We may be influenced by a dynamic speaker at a conference who makes one type of therapy sound so reasonable even though we may know there is no real evidence to back it up.

We also need to be aware that financial incentives, workloads, hospital and office staff opinions and many other pressures may influence certain patient care decisions if we allow them.

We health professionals often think of ourselves as being very objective when it comes to patient care, but when we think about it further, the certainty of that assumption may fade a little. The first thing to do is to try to be reflective enough to realize when there might be a problem. Once you recognize it, then you can usually fix it. It’s like many other aspects of being a professional. It’s impossible to be perfect at it, but we have to keep trying, and that's what makes us professionals.

This page was last updated on March 23, 2011.

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