The possible impact of vulnerability on clinical communication: Some reflections and a call for empirical studies

To direct attention to the concept of vulnerability, how it affects interactions in subtle ways and is difficult to detect in studies of clinical dialogues.

A reflection on three everyday examples of what seems like insignificant details in physician-patient interaction, enlightened by readings with an emphasis on unacknowledged shame, illness and social bonds, and the physician's role.

Physicians are aware of patients' vulnerability as risk and susceptibility to harm under certain circumstances, but often miss the vulnerability related to perceived or anticipated loss of social bonds. The latter may elicit unacknowledged shame, which leads to subtle behavioral changes that are easy to overlook. Typical reactions are silence or lack of relevant response to questions. Physicians are rarely aware of their own vulnerability. Slight behavioral changes from a clinician may reduce or increase a patient's ability to partake actively in problem solving and decision-making.

When physicians or patients are touching upon unacknowledged shame as part of being vulnerable, subtle changes in the interaction may hamper efficient communication.

We need studies that add participants' unprompted and prompted reflections on encounter videos, with an emphasis on micro-events and their explanation and impact on the interaction.