A ‘zone of openness’ is one of the main tenets of patient advocacy & engagement… so why does it sound so foreign to so many of us?
The term itself is fairly new in practice, though the theory has been around since the days of Seinfeld. An article about the PCORI project associated with this term explains the main issue:
In a 1996 episode of the television show Seinfeld, Elaine objects to putting on a paper gown because the rash that brought her to the doctor’s office is already visible on her arm. After she challenges the label of “difficult” that she sees in her chart, the physician refuses to take her rash seriously. A doctor Elaine subsequently visits sees the notation in her chart and also disregards her problem.
Although this scenario was played up for laughs on TV, real-life patients do worry about being perceived as difficult, researchers at the Palo Alto Medical Foundation Research Institute (PAMFRI) learned in a recent study. Patients believe such a label can lead to lower quality care. “We refer to ‘Elaine’ when we discuss this fear,” says Dominick Frosch, PhD, formerly of PAMFRI and now at the Gordon and Betty Moore Foundation.
The zone of opennes, then, is the creation of a space where an ‘Elaine’ cannot happen, where patients’ concerns and issues are fully heard and understood by their physicians, and where physicians act on that information instead of creating negative personality-judgment comments that really have no place being in the chart anyway.