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7. Hi, Felicia. Let’s Go Bar Hoppin’ !

Updated: Sep 5, 2023

How non-judgmental trust-based relationships help patient engagement specialists better navigate their role as reluctant confidants

One of my favorite things about working with the life science industry’s patient engagement specialists, particularly clinical nurse educators, are their insights about the freeness by which complete strangers will often willingly disclose private, and frequently off-topic, personal information. Regardless of the fact that their primary objective is to provide information and education about their client’s product or services, nurse educators often became a de facto set of broad shoulders on which life’s bigger challenges are laid. The educators were, of course, always careful not to broach the wall of patient confidentiality when discussing the sad and poignant, but often humorous, stories of their role as a “reluctant confidant”. But it was clear they cherished the trust patients placed in them.

“I sometimes wonder when I go into a home, I’m like, ‘Am I on Candid Camera or something?’ Sometimes I’m like ‘Is this real? I can’t believe it, are they testing me?" -Gabi [1]
You put your eyeballs back in your head and sit and let them tell you because they obviously feel comfortable and there’s a reason they’re telling you. It’s usually a therapeutic thing for them to be able to tell somebody.” -Deandra [1]

Another surprising example was the pharma field nurse educator who shared with me a “business tip” proffered by one of her patients with Type 1 diabetes. When the educator asked her young adult female patient about the gaps of missing data in the mobile app connected to the continuous glucose

monitoring (CGM) device she was directed to wear at all times, the patient had an unexpected explanation. The patient shared that in her line of work as an exotic dancer, she found she made better tips when she didn’t wear the CGM while performing, so she would remove it. To her credit, the educator acknowledged the legitimacy of the patient’s necessary occupational adaptation and simply

impressed upon her the importance of reapplying the device as soon as she stepped off stage. Such a tale speaks to the importance of patient engagement specialists establishing a strong, non-judgmental trust relationship with patients so they are comfortable disclosing the many unique variables that can impact disease and treatment management.

All of this makes me think of the theme discussed in the last post “Trust Me, I’m a Nurse. (The Rehabilitation of Hot Lips Houlihan)”. As discussed in that post, nurses have been ranked as the most honest and ethical profession every year but one between 2000 and 2023 by Gallup’s annual public opinion poll on the topic [2]. Further, during my interviews with pharmaceutical nurse educators for my doctoral research, I learned that the perception held by nurse educators was that they enter their educational and coaching engagements with patients with a beneficial amount of trust already instilled in them. Accordingly, educators believed that this predisposed trust worked toward their advantage when soliciting information from patients.

However, insights from the academic literature could suggest another interpretation for educators’ perceptions of assumed trust. One relevant explanation is Petronio’s [3] concept of “trust credit points.” These are figurative increments of trust given to an information recipient from the discloser that can increase or decrease based on how the recipient manages the disclosed information. If the recipient breaks negotiated privacy rules, he or she loses points and must engage in actions or a renegotiation of rules in order to restore them. In other words, pharma nurse educators perceived patients as providing them with many trust points at the start of their engagements. As long as educators maintain their expectations and obligations for patient privacy, they held on to those points. Tabitha, a nurse educator from my study, put it this way:

“I think right from the get-go, we are trusted. I really do believe that.…I think we start out on top and if we screw up, that’s when we’re going to kind of fall down on the scale.” [1]

Another possible explanation discussed in the literature is that patients’ willingness to automatically instill trust was the result of the patients’ functional need to receive healthcare [4]. In other words, patients trusted educators and were willing to disclose information to them because they knew that, in exchange, the educators would assist them with their healthcare needs. Petronio [3] goes on to explained that professions such as nurses fall into a type of “reluctant confidants” she referred to as occupational confidants. These are individuals who are disclosed extraneous or unsolicited information as a result of their occupation. Other examples include bartenders and hair stylists.

Felicia, a participant in my study, was a pharmaceutical field nurse educator who joyfully shared numerous stories and anecdotes about her experiences as a reluctant confidant. She delivered training for an osteoporosis medication in an area of the country known for having an affluent population of retired and widowed women. During her interviews with me for my study, she affectionately referred to her patients as “my little old ladies” and took great pleasure in engaging them in conversations during her product education sessions. She felt that many of her patients equally enjoyed her company as they would freely disclose information about themselves. She put it this way,

“Oh, God. Well, most of the patients, if I could stay there for hours, they would tell me their entire life story.[1]

She continued by offering examples of the various non-therapy-related topics patients would broach and how those conversations have even given way to invitations to join them for social outings that seemed reminiscent of an episode of The Golden Girls. She shared:

“I’ve heard about children’s death, divorce, cheating husband, woman followed her husband to the car dealership and caught him with this girl. It’s amazing! I’ve been invited to go for drinks with a group of 75-year-old women looking for men.[1]

Felicia later admitted that, while such socially enriching experiences made her job enjoyable, they also made it challenging from a time management perspective. She noted,

“My first osteoporosis patient was a two-hour visit. She told me about her husband, the divorce, the girlfriend, the this, the that. I walked out going, ‘I’m not going to get any work done if every visit is like this." [1]

After sharing these examples of the ease by which patients disclosed voluminous amounts of personal information, I asked Felicia why she thought her patients seemed so willing to divulge their life stories to her. She attributed their actions simply to the fact that she was willing to sit there and listen. She stated,

I sit and listen. The other day, I got up and I had to hug the woman because she started crying, telling me about the death of her daughter. I don’t know, I sit and listen.” [1]

All of these stories help illuminate the core principles of relationship centricity (see blog Post 2 “Zen and the Art of Relationship Centricity”). They reinforce the notion that the life science industry’s pursuit of a purely patient-centric approach to engagement can fall short as it frequently doesn’t account for the power and influence of the relationships that are established by the industry’s patient engagement specialists. By supporting such interpersonal connections, the industry will be better positioned to nurture the types of patient behaviors that lead to better health outcomes.

[1] Barshinger, T.A. (2020) Interpretations of communication experiences of pharmaceutical-sponsored clinical educators (Doctoral dissertation). Retrieved from ProQuest Dissertation and Theses database (UMI No. 28086978)

[2] Brenan, M. (2023, January 10). Nurses Retain Top Ethics Rating in U.S., but Below 2020 High. Gallup.Com.

[3] Petronio, S. (2002). Boundaries of privacy: Dialectics of disclosure. State University of New York Press.

[4] Petronio, Sandra, DiCorcia, M., & Duggan, A. (2012). Navigating ethics of physician-patient confidentiality: A communication privacy management analysis. The Permanente Journal, 41–45.


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