The inspiration for this blog is from the Springer Nature journal Social Theory & Health (ref:https://link.springer.com/article/10.1057/s41285-024-00208-3) where the authors classified six different types of patient knowledge. In other words, six ways that patients’ lived experience are unique and essential for healthcare professionals.

• Embodied knowledge
• Monitoring knowledge
• Relational knowledge
• Medical knowledge
• Cultural knowledge
• Navigational knowledge

Understanding Relational Knowledge: The Cornerstone of Effective Patient Care

During their lived experience of their conditions, patients have to navigate not just the intricacies of their illnesses but also the network of relationships that play a crucial role in their care. This network —known asrelational knowledge—is a vital yet often underappreciated aspect of the patient experience. Within medical education, understanding and articulating the nuances of relational knowledge is essential in capturing the full scope of patient care.

How relational knowledge is built

Relational knowledge is when patients develop an understanding about who to turn to for support, advice, and care within their communities and the healthcare system. They inevitably have to identify the key individuals and organizations that form their care team, both formally (like doctors and nurses) and informally (like family members, friends, or community support groups). It’s not just about knowing who these people are; it’s about understanding how to effectively engage with them to access necessary care and support (both physical and mental).

Relational knowledge also involves knowing when and how to activate these relationships. This means understanding the right time to seek help from different members of their care network to minimize disruptions in their lives and maximize their ability to live well in their communities. Patients learn to navigate these relationships strategically, ensuring they get the most out of each interaction without overburdening any single relationship.

Building relational knowledge can be critical for patient well-being. As patients identify, navigate and build their network of relationships, they evaluate them on a trust scale, ranging from complete trust to none at all.

Trust is not static or homogenous – it varies based on the situation and the specific needs at any given time. For example, a patient might trust their primary care physician implicitly but turn to a peer support group for emotional support and practical advice. For example, the NTRKers are a global, non-profit patient group, founded by patients and their families living with NTRK gene fusion cancer. As part of their remit, they provide support and education for patients and their care partners. There are many other patient-led organizations providing much needed support – like Diabetes UK, the MS Society, and the Myasthenia Gravis Foundation of America.

In other situations (for example in ultra-rare conditions), patients may experience suboptimal treatment due to HCP lack of awareness and/or misdiagnoses. This can lead to a breakdown of patient-HCP trust, which an negatively impact their relational knowledge dynamic and can lead to them stopping seeking care, or engaging in self-medicating in ways that may negatively impact their health. In our2022-2023 program on the ultra-rare condition fibrodysplasia ossificans progressiva (FOP),* a patient described his experiences with well-meaning  healthcare providers who did not know about this rare disease, which led to biopsies and tetanus injections, which ultimately led to disease progression. These negative experiences led to the patient becoming sceptical of healthcare and reluctant to seek help until he found a doctor with great experience in treating FOP.

Navigating Social Codes, Norms, and Roles

When patients are building their network of relations, they have to come to understand the roles and communication codes within their own healthcare environment – i.e. knowing how to communicate effectively with doctors, nurses, and other professionals. This includes understanding the specialties and complementary roles of different healthcare providers, coordinating their care efforts, and avoiding potential conflicts.

Relational knowledge also helps patients develop the judgment needed to engage in these relationships meaningfully. It’s about having the right words and communication strategies to ensure their needs are understood and addressed by different stakeholders in their care journey. This is not always easy – especially when we might be stressed or anxious during times of illness or communicating with healthcare professions or within peer support settings.

Empowering Patients Through Relational Knowledge

Relational knowledge can be a great means of empowerment. Once patients can successfully understand and manage their network of relationships, they can exert greater control over their care and life goals, which means they can increase their quality of life, achieve greater autonomy, and become a more active participant in their care.

In peer support settings, relational knowledge is especially valuable. It fosters therapeutic relationships where patients can share experiences, offer guidance, and help each other navigate the complexities of healthcare. This collective knowledge sharing often leads to improved outcomes for everyone involved, enhancing both quality of life and independence.

What does this mean for medical education?

Acknowledging and highlighting relational knowledge is crucial. It shows that the patient experience that goes beyond clinical care, and includes social and interpersonal dynamics – which can significantly impact health outcomes. Relational knowledge can open up opportunities to create resources that better support patients in developing and managing these essential relationships.

How can we incorporate this into medical education?

• When developing medical education, consider collaboration opportunities with a patient advocacy group (PAG). Not only can they provide insights into patient lived experiences, but they also often work with caregivers and loved ones and how their roles can be supportive. They may also be able to consider content endorsement or co-collaboration if your goals in improving patient care are aligned
• Speak to patients and their caregivers openly – insights from those with lived experience can truly help to develop next-generation materials
• Consider patient resources for newly diagnosed patients that explain the patient pathway: Who are the HCPs they are likely to encounter? What do they do? How can they help you? What should you be asking them?
• There are many other patient-directed resources that can be created to support patients in developing relational knowledge – such as signposting support networks, patient organizations, and PAGs, to ensure that they become equipped to use their networks for empowerment

Do you have other examples of how relational knowledge can be incorporated into medical education programs? Please comment or share – I would love to hear from you!

Stay tuned for the next blog, which will speak on cultural knowledge.

*Made possible thanks to an independent educational grant from Ipsen.