The doctor in the sample who chose to conduct the ward round from his consulting room with patients sitting in a chair enabled the adoption of an empowering body language, which in itself can help adjust the power balance. The criteria for conducting the round in this way was for patients to be cognitively alert, capable of leaving their room and getting dressed in their own clothes. This process naturally mobilises patients who will therefore recover more quickly from their illness. The fact that they are dressed in their own clothes rather than a hospital gown steers them out of the patient role (2).
One study that looked at the effects of sitting versus standing by the patient’s bedside showed that if the doctor sits down, patients will feel they are given more of their time (25, 26). The patients also said they felt important when the doctor sat down. The real time spent on the patient remained the same whether the doctor was standing or sitting, but patients felt that doctors who sat down spent more time on them.
To a certain extent this alternative ward round can be said to have altered some aspects of the traditional roles of doctor and patient. The patient’s passive and dependent role was challenged, and perhaps the doctor’s role of exclusive expert was somewhat moderated. This way of conducting a ward round potentially points to a new role complementarity. For doctors and nurses the role of non-exclusive expert emerges, while the patient role is more active and independent.
One practical measure adopted by some hospitals is the introduction of visitor chairs (27) during ward rounds. These chairs are brought on to the ward while doctors conduct their rounds, thereby obliging them to sit down when talking to patients. The visitor chairs tend to signal time and respect for the patient, and they facilitate good dialogues that may reduce the risk of errors and misunderstandings.
Ward managers and senior hospital staff thus carry a great burden of responsibility to facilitate each individual doctor’s efforts to promote patient empowerment. The limited availability of rooms that lend themselves to sensitive conversations warrants criticism.
The job of leading a culture-changing process is a demanding one. There is much evidence to suggest that managers fail to act as good role models. Moreover, staff frequently receive no training in how to use specific tools that may enable them to carry out their work in a more person-centred way. Moore et al. (28) concluded that the absence of clear leadership is one of the most conspicuous obstacles to patient empowerment.
Based on our analysis and on the field data we have collected, this article has observed that internalised roles impact significantly on hospital ward rounds. Doctors and patients assume their roles subconsciously, with doctors playing the part of exclusive experts and patients playing the part of passive and dependent recipients of care.
The findings suggest that these roles contribute to a form of patient disempowerment. The role assumed by and given to doctors is not necessarily overtly paternalistic, but the traditional role of doctor can divest patients of their autonomy.
Patients on the other hand, often have no opportunity to take control of their own situation because their illness, and the expectations associated with the patient role, put them in a subordinate position. They lie down on the bed even if they think that being bed-bound makes them powerless.
Accordingly, the traditional roles of doctor and patient, and the power and powerlessness vested in these roles, affect their communication and interaction. There is a potential to challenge the traditional roles and strive towards achieving a role complementarity made up of the roles ‘non-exclusive expert’ for doctors and nurses and ‘more independent’ for patients.
It is tempting to point out that doctors, nurses and patients need to practice their ‘non-exclusive expert’ and ‘more independent’ roles. In particular, doctors and nurses should perhaps be encouraged to reflect on the power they hold and familiarise themselves with the power imbued in their professions. Better understanding of roles and power may be required if we are to see a change in the way they enact their roles.
It is too simplistic to argue that it is down to the individuals concerned whether the ward round becomes a successful arena for service user engagement. The most important prerequisite for breaking away from the established roles is to change various organisational and physical practices associated with the ward round.
This article has highlighted various ways of changing the physical and practical ward round arrangements. Clear leadership and training can facilitate a change from traditional to empowering practice.
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