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The Patient Comes First – A Decision Game on Patient Subjectivity in Healthcare
Exercise #29
The Patient Comes First – A Decision Game on Patient Subjectivity in Healthcare
Authors: Magdalena Stankiewicz
25 minutes
Description
An interactive, case-based exercise in which students explore patient-centred care and develop empathetic, collaborative communication skills. Through role-play simulations, students learn to treat the patient as an active partner in the therapeutic process, strengthening patient autonomy and shared decision-making.
Methodological Guide
Objectives
Recognize the importance of treating the patient as an autonomous subject in clinical interactions. Apply communication strategies that enhance co-determination and shared decision-making. Support patient autonomy through partnership dialogue. Reflect on ethical and legal implications of patient subjectivity. Evaluate your own communication habits and their impact on patient agency.
Expected Outcomes
Understand the patient's role as an autonomous agent in healthcare. Use strategies that support co-determination and partnership. Reflect on your own communication patterns and areas for improvement. Apply practical skills of shared decision-making.
Exercise Procedure
Stage 1 — Decision Scenario (15 min): Navigate a branching decision tree centred on an 82-year-old patient with advanced heart failure who asks 'Am I dying?' while his family has asked staff to stay silent. Your choices determine the outcome. Stage 2 — Written Reflection (10 min): Respond to a reflective prompt on what made patient-first feel harder than it looked on paper.
Mode of Implementation
Mixed: individual + small groups (2–3 people). Role rotation: patient → doctor → observer. Adaptable to face-to-face or online delivery (breakout rooms).
Role of the Teacher
Moderator: maintains constructive dialogue and psychological safety. Feedback provider: reinforces effective communication behaviours. Facilitator: helps students translate game experience into clinical practice.
Theoretical Basis
Transformative Learning Theory (Mezirow): Disorienting dilemma — clinical cases where the patient's voice is limited; Critical reflection — students question how often decisions are made 'for' the patient without them; Dialogue & action — developing strategies to strengthen patient subjectivity. Experiential Learning (Kolb): clinical simulations (doctor–patient–observer), case study analysis, shared decision maps. Social Constructivism: understanding communication as co-created through interaction.
Practical Application
Practising conversations where patients express expectations and preferences. Training core tools: paraphrasing, open questions, teach-back method. Applying shared decision-making techniques in everyday practice.
Knowledge Transfer
After each simulation, students answer: 'How did my decision affect the patient's sense of agency?' Reflections are recorded individually and discussed as a group.
Reinforcement & Reflection
360° feedback from patient, doctor, and observer. Subjectivity Scale (1–5). Reflection sheet prompts: What made the patient feel like a subject? What reduced their influence?
Required Resources
Case cards (3 scenarios). Reflection sheets. Subjectivity Scale. Board or Mentimeter. Notes for micro-contracts.
Assessment / Evaluation
Self-assessment: reflective journal entry. Peer assessment: observer feedback during simulations. Teacher observation: quality of participation, depth of reflection, communication strategies applied.
Practical Tips
Encourage pauses and open-ended questions. Use teach-back to check understanding. Provide clear, behaviour-based feedback. Adaptable to online delivery.
Discussion Topics
When does patient autonomy end and physician responsibility begin? How does the law support or limit patient subjectivity? What biases influence whether we listen to patients?
Stage 2: Written Reflection
You have just navigated a palliative care dilemma where patient autonomy and family wishes pulled in opposite directions. Now write a short personal reflection. There are no correct answers — only honest ones.
- What made 'patient first' harder than it looks on paper?
Stage 2: Written Reflection
You have just navigated a palliative care dilemma where patient autonomy and family wishes pulled in opposite directions. Now write a short personal reflection. There are no correct answers — only honest ones.
- What made 'patient first' harder than it looks on paper?
Further Resources
Reading recommendations on shared decision-making. Follow-up journal assignment: analyse one real clinical situation focusing on patient subjectivity.
Additional Remarks
Easy to adapt for online simulation. Video examples may be added in extended versions. The Subjectivity Scale (1–5) is a paper-based rating tool from the original methodological guide and is preserved here with a 1–5 scale and student explanation.