Partnering with your healthcare team

A #CRArthritis interview with Laura Nimmon – Social science in rheumatology

We had the privilege of chatting with Social Scientist Dr. Laura Nimmon at the Canadian Rheumatology Association (CRA) Annual Scientific Meeting and Arthritis Health Professions Association (AHPA) last month. Laura is an assistant professor in the Department of Occupational Science and Occupational Therapy, as well as a scientist at the Centre for Health Education Scholarship at the University of British Columbia. Laura shared her time with #CRArthritis and sat down with us to answer some questions we had. As patients, we find her research meaningful, and we think you will too! Below are some highlights of the in person interview.

What is a social scientist and what do they do?

Social science is a broad field but can generally be categorized by the study of human society and social relationships. Social scientists aim to understand how our society works and will often use the information they gather to create or promote change within the society.

As a social scientist, how did you become involved in rheumatology?

I entered into the field of rheumatology by being awarded The Arthritis Society Young Investigator Salary Award, which gave me an opportunity to do research in the area. My focus is on teamwork. I look at how healthcare teams coordinate patient centred care and some of the tensions and social dynamics that exist in these interactions. I am conducting this research alongside an incredible team of colleagues consisting of health professionals and patient partners; it is a wonderful combination of minds with different experiences and backgrounds.

Could you share with us the key messages from your presentation at the conference?

We foreground our presentation by looking at how negotiations around care are always conducted from positions of power. This sort of tension is inherent on healthcare teams because healthcare professionals have a legitimized expertise and social power that is ascribed to them. Their knowledge is understood as being scientific and sophisticated whereas patient knowledge is considered the opposite of expertise; it is viewed as non-scientific, lay and experiential. This gives healthcare providers a very strong, sort of symbolic power card. Through our presentation, we want to bring attention to the social dynamics that exist between patients and healthcare providers, such as power and trust, and how they affect patient care.

What do you think about this year’s meeting theme of precision and personalized medicine?

This year’s theme of precision and personalized medicine is very exciting and will undoubtedly augment patient care. It is based on genetics and allows patients to receive individualized diagnosis, prognosis and therapy estimates specific to their genome. While this is exciting, diagnosis and appropriate treatment is only one dimension of good care; personalized medicine also needs to be coupled with relationship-centred, person-centred approaches. Person-centred care focuses on the patient and their contextual circumstances- values, beliefs and preferences. The person-centred approach is needed for precision and personalized medicine to be successful. For example, the patient must agree with and adhere to the treatment plan, and if the relationship between the provider and the patient is dysfunctional or lacks trust, then this can be difficult. It is really important that we don’t lose humanistic aspects of care in all the excitement of technological advancements.

On the subject of technology, how do you think digital health and social media play a role in patient care?

It is an amazing time, unprecedented- in term of patients’ ability to access information online and to educate themselves. These sources of information can hold a lot of weight for patients, whether it be a family member with the same disease or medical information they find online. It changes the provider-patient relationship because the expert advice from the provider gets diffused a little bit through all the information the patient is gathering on their own. There is research that says when a provider acts in a judgmental way or they do not agree with what the patient has learned, the patient responds by blocking that person’s influence. The patient either finds a new provider, or they just stop communicating with them about what they are learning. This is a departure from what should be a cohesive network of communication amongst all members of a healthcare team.

Based on your research, how do you hope arthritis models of care will advance in the future?

More social scientists are tackling the problem of teamwork in various domains of chronic disease care. I think this influx of social scientists and the different lenses they take to study social processes, will deepen our understanding of power dynamics and the way teams work. Human dynamics are really complex, and I am hoping that future models of care will help deal with these nuances. It would be ideal for healthcare providers to be taught as part of their education about power dynamics, to be aware of the power they inherently possess, how to manage this power and how to negotiate in a respectful way with other team members and with patients and loved ones.

What advice would you offer patients and healthcare providers to help reach this goal of seamless teamwork?

It is important for patients to share what they are learning with their providers and it is equally as important for providers to engage in these conversations and be non-judgmental about what patients are learning. I also think it’s important that healthcare providers know who is on their patients “team”. Often the biomedical understanding of a healthcare team is just other health professionals, but patients have broad healthcare teams, comprised of friends, family, sometimes spiritual advisors and maybe even people like their bus driver. There are many people that patients go to for support and guidance around their health. Mapping this out with providers, telling them who is influential in that network is really important. The provider can call that person or ask them to accompany the patient to their appointment. This would allow for less of an isolated interaction between the patient and the healthcare professional- it would allow for a more holistic systems approach to care.

In a field normally focused on bio-medical approaches, this social science perspective is an important and crucial one. We learnt from Laura that good care is more than a timely diagnosis and a suitable treatment plan; good care is trust, understanding and mutual respect between the patient, their personal support system and their healthcare provider(s). Good care is united teamwork.

Thank you so much for your time, Laura!