The patient's chair: a blog by Dr Faisal Saeed

Summary

In this blog, Dr Faisal Saeed talks about the patient-provider power imbalance using an AI generated image of two chairs to illustrate his points. 

Content

When Vincent Van Gogh painted the empty chairs, it was his purpose to distinguish the two chairs; his and that of Gaugin’s. Van Gogh’s chair is painted to be less mystical; straight backed and with no armrests, made of plain unpolished wood. Gauguin's chair was a more ornate and luxurious piece of furniture, with a high back and a carved seat. The chairs were a reflection of the two artist’s personalities and their relationship with each other. 

While visiting the Van Gogh Alive festival in Adelaide, these paintings of Van Gogh’s chairs stood out at me because I have always found it uncomfortable when I had to point to a simple chair (a backless stool or a plastic chair without armrests) to sit down for my patient, while I was sitting in an imposing high back black leather executive chair with padded armrests, lumbar support, back and head rest adjustment and a swivel base. 

The image below is an AI generated image. I used the prompt: “painting of a doctor's chair and a patient's chair in a consultation room, painted in the style of Van Gogh”. Guess which chair is the patient’s chair? The concept is so ingrained in society that even generative AI and natural language processing models take it for granted that the patient should be seated in the smaller chair. 

Since early history, elaborate chairs have been used as a symbol of power by the higher strata of the society – kings, priests and the like – and the simpler backless version of the chair, the stool, is used primarily by the lower strata. Authority, domination and power is what come ultimately to mind when one thinks of chairs (Danto, 1987).

The design and the use of the chair is deliberate and the the symbolism is still evident today. It is no accident that the high-ranking officials are given the best and expensive chairs positioned at the front, while others sit in less conspicuous or cheaper ones. It is designed to show power and status. 

Given the power imbalance between the doctor and the patient, with the seemingly powerful situation the doctor is given in the relationship due to the deference to expertise, the simple chair the patient sits on only acts to reinforce the power imbalance. 

As it is, several barriers exist that make patients hard to speak up, even where patients are well-informed and well educated. Many patients feel they can’t participate in shared decision-making, and the power imbalances are a key barrier even if patients have the knowledge (Joseph-Williams, 2014). 

Because patients must have equal power in the relationship as a partner in care, it is time we do not make this distinction in the design of the clinical environment. The patient is an equal partner in the therapeutic relationship and is very much an expert in the lived experience of their illness. 

We cannot imagine two leaders of a company being shown two very different types of chairs – one simple and one expensive – when seated to discuss and finalise on an agreement. 

Why must it be any different for the doctor and the patient? 

About the Author

Faisal Saeed is a doctor with a health law background, based in the Maldives. In Law school, he learnt about the devastating consequences of harm in healthcare. He has since combined the knowledge of medicine and law, quality and safety and clinical trials picked up on the way, and his hobby of graphic design, to visualise and communicate data and ideas.

He has focused his career towards patient safety and quality improvement to ensure we provide care in a way that minimises harm.

"When I explained what I do at the hospital to my 6-year-old son, he said "...so, your job is to remind doctors to be kind to their patients?" I think he summed up rather well what I do: regulating healthcare professionals, developing policies to improve quality and standard of care, managing risk and listening to patient concerns, so that I can drive a change in culture towards one that is centred around the patient."