I have written in other articles that the patient voice agenda and the assumptions it rests on, namely patient-centred care and patient empowerment, only apply to some. One of the key barriers to advancing this agenda is the quality of information patients have access to. This includes the information they receive, such as a Package Leaflet, but also the information they actively seek and the channels they use to find it. One immediate and direct way for patients to seek information is by asking their healthcare provider during a consultation, while they are in their presence. However, many patients hesitate to voice their concerns due to the need to maintain face. This is a concept that refers to a person’s social self-image and the desire to be regarded favourably.

Face maintenance plays a crucial role in patient engagement, particularly in how they seek and process medical information. If asking questions or expressing concerns risks making them appear uninformed, defiant, or non-compliant, patients may choose silence over participation, leading to misunderstandings and reduced involvement in their own care. To support meaningful engagement, healthcare professionals must ensure that patients feel safe to ask questions without fear of losing face.

The way face maintenance operates in healthcare is complex. Patients may feel vulnerable when seeking medical advice, as their knowledge, autonomy, or lifestyle choices may be questioned and judged. Meanwhile, healthcare professionals may perceive questions or challenges as threats to their authority. Many patients hesitate to ask questions for fear of appearing uninformed, being seen as difficult, or due to cultural norms that discourage questioning authority figures. Past negative experiences can also make them reluctant to speak up. Yet when patients feel comfortable expressing concerns, they are more likely to adhere to treatment, receive accurate diagnoses, and build stronger relationships with providers. However, as we have discussed previously, patients often do more face work to uphold the doctor’s authority than vice versa, calling into question how much shared decision-making truly occurs.

For patient voice to be strengthened, the way information is delivered matters. Overly technical language, dismissive attitudes, and information overload can all discourage engagement. Face-sensitive communication strategies can help avoid this. Positive politeness affirms the patient’s role in decision-making:

I appreciate you thinking through the options. Let’s review them together.

rather than…

Just take the medication I prescribed.

Negative politeness respects autonomy:

Would you like to explore some alternative dietary options?

 instead of…

You need to stop eating unhealthy foods immediately.

Framing information as shared discovery encourages participation:

Many patients find small changes helpful. So, what might work for you?

rather than…

 You must exercise more, or your condition will get worse.

For patients to feel confident using their voice, healthcare providers must create an environment where asking questions does not feel like a face-threatening act. This means normalising questions, using clear and accessible language, and ensuring information is presented in ways that empower rather than intimidate. Encouraging open dialogue, recognising patients’ lived experiences, and creating a safe space for discussions are also key to reducing barriers to engagement.

Face maintenance shapes whether patients feel comfortable speaking up in healthcare interactions. When patients fear losing face, they may remain silent, leading to misunderstandings, disengagement, and poorer health outcomes. By providing clear, respectful, and face-sensitive information, healthcare professionals can build trust and encourage active participation in care.

As patient-centred care evolves, recognising the pragmatic aspects of communication will be crucial in fostering more effective, respectful, and meaningful healthcare interactions. When patients are supported with quality information and a face-sensitive approach, they are more likely to engage, leading to better health outcomes for all.

Thank you for reading.

Mark Gibson

Boston, USA, November 2024