Holding Space Is the Critical Piece Missing In Most Medicine Today

“Hi, how are you feeling today?” It sounds like a simple greeting, one of several questions I might ask when my patient materializes in front of me on the computer screen or in my office. But it’s more than just small talk for me; it’s one of the first medically significant inquiries I’ll make in the course of each thirty or sixty minute appointment I have with one of my patients. It’s also the key to a practice that’s often missing from medicine, but one that’s vital to the care that Parsley Health’s physicians and health coaches provide: holding space.

When my patients hear that question, they often let out a long sigh of relief. This is officially their time: we are here, together, to discuss how they’re doing and if their current reality is reflective of how they would like to be feeling. Often, we’ve been building this dialogue for many months, laying a foundation of trust to begin collaborating on the project of helping them to feel their best. My patients are comfortable enough to share some of their most intimate concerns, aspirations, and fears about their body with me for one simple reason—they know I’m holding space for them to do so.

What does holding space actually mean?

Learning to ask the right questions is a big part of the process of becoming a good physician. As clinicians, we’re trained to ask the kinds of urgent questions that might lead to a previously unrevealed diagnosis or life-saving medical intervention. But the practice of medicine is more than asking the right questions; sometimes, it’s knowing how to sit back and actually hear our patients when they’re giving us the answers. Being a good listener falls into the category of skills that comprise the art of medicine (as opposed to the science, which is also vital) and is an essential part of how we hold space for our patients.

Holding space isn’t just listening though: it’s also being fully present with a patient, and creating a safe, compassionate, and non-judgmental environment where they can be vulnerable. Yet, a 2018 study in the Journal of General Internal Medicine found that only 36 percent of doctors ask questions that elicit a patient to discuss their concerns, and when they do, patients were interrupted seven out of ten times.

Achieving the type of conditions that are favorable for developing solid patient trust and communication requires a considerable commitment of time and emotional investment on the part of the physician. On top of that, many doctors face constraints such as limited time and the pressure to maintain efficiency, limiting their ability to develop open, in-depth dialogue with their patients. As most of us already know, vulnerability isn’t easy.

Parsley Health’s approach to care values the intrinsic connection between mental, emotional, spiritual, and physical health. We know there is real medical value to considering the full spectrum of factors that affect a patient’s attitude about their health and medical care, including prior experiences, spiritual and cultural beliefs, and community and social support.

Why holding space is the key to better medical care

Research shows what lots of physicians already know: effective communication leads to better health outcomes . In fact one study in the journal PLOS ONE found that measures designed to improve the doctor-patient relationship resulted in health effects just as beneficial as taking a daily aspirin to prevent a heart attack.

We’ve also seen the disastrous effects of ineffective communication and what happens when providers don’t create a psychologically safe environment for patients, particularly for marginalized communities.

A 2017 study in the Journal of Racial and Ethnic Health Disparities found that Black patients consistently experienced poorer communication quality, information-giving, patient participation, and participatory decision-making than white patients. And a report by the advocacy group, Lambda Legal, found that more than 50 percent of lesbian, gay, or bisexual survey respondents and 70 percent of transgender people had experienced discrimination while seeking health care.

Not feeling respected or being looked down on within the doctor-patient relationship can influence how patient’s utilize health care moving forward, finds research in the Journal of Family Practice . 14.1 percent of Blacks, 19.4 percent of Hispanics, and 20.2 percent of Asians perceived being treated with disrespect or being looked down upon, compared with only 9.4% of whites.

Research also suggests that women (in particular, women of color) are more likely to receive less effective care than white males.

At Parsley Health, everyone from our doctors and health coaches to care managers and staff seek to create a safe space for everyone to receive the best possible medical care. There are a few ways we make this work:

• We have time, a true luxury in medicine today; my patient appointments are anywhere from thirty to sixty minutes, with plenty of time for the type of in-depth conversations required to get to the core of my patient’s health concerns.
• We create access. Our membership portal allows patients unlimited messaging with their doctor, health coach, and care manager – the rockstar team who help guide our patients along every step of their wellness journey.
• We have emotional availability. Most importantly, I know that my patients can’t develop the type of trust in me that will allow them to be truly vulnerable unless I get in that space with them. So, I do; I share my own stories, painful struggles, and life-affirming triumphs. I meet them where they are, because I understand what it’s like to yearn for the changes that will finally put them back on the road to feeling better, and to also feel utterly overwhelmed by the prospect of taking that first step. I consider this one of the key ingredients to holding space for my patients, but it also comes from a simple place: I’m a patient too. You may not think about your doctor like that, but remember, when I’m sitting in my doctor’s office, I’m not different than you! I get scared, anxious, frustrated, and relieved. I am looking for empathy, a connection, and the space to be fully heard by someone invested in my healing and growth.
• Our care is rooted in collaboration: we’re building a treatment plan together, based on what your individual health goals are, and your superior understanding of your own body and preferences. When we build something together, we’re both invested in the process and progress: you trust me to help create a plan for you that will address your most important goals and concerns, and I trust that you will implement the plan we’ve made together to continue taking the next steps forward. Furthermore, you know that your Care Team will be there to support you at every point in the process, with empathy and honesty. That’s the power of holding space.

My biggest patient success stories tend to come from those who keep an open line of communication with both me and their entire Parsley Health Care Team. That means engaging in important decisions about their treatment plan and fully utilizing their member resources, most significantly the reinforcement and affirmation of a close relationship with their health coach. Which speaks to something pretty crucial about the idea of holding space; it tends to work best when you’re also holding it for yourself.