Fostering Physician-Patient Partnerships: The Importance of Embracing the Ontological and Epistemological Understandings of Knowledge.

introductionHealthcare is becoming substantially complex in part due to greater multimorbidity, climate-related health issues, and problems related to access to care. While patient partnership is widely advocated as a strategy to adapt medical practice to the complexity, significant barriers persist.

aimWe sought to shed light on the ontological and epistemological 'tensions' generated by the implementation, sometimes by imposition, of the concept of physician-patient partnership in medical practice.

methodsThis reconceptualization of the distinctive ways of knowing is based on illustrative physician-patient interactions used to contrast the fundamental belief-systems that generate ontological and epistemological tensions impeding physician-patient partnership. We contrast knowledge valued by the prevailing positivist paradigm with the kinds of knowledge patients can contribute to ensure optimal healthcare outcomes.

findingsIdentifying the complementarity of evidence-based and experiential knowledges leads to a paradigmatic shift in how we perceive, interpret, and use data in the clinical setting. The two co-existing but distinct ontologies and epistemologies-neither is inherently superior to the other-are essential for a broader and concrete understanding of illness, its experience and its management.

conclusionThis exploration into the complex nature of physician-patient partnerships provides insights about avenues for strengthening them and making them fulfil their promise to enhance health care access and outcomes for all. PATIENT CONTRIBUTION: The first author is a kidney transplant recipient (2008) and has been actively involved in patient partnership within health research and medical education since 2010. This paper reflects his accumulated insights and observations regarding the barriers that hinder the development of effective partnerships in health care.