Structural Asymmetry in the Clinical Encounter Understanding, Power, and a Proposal for Voluntary Patient Support Presence

This paper examines the structural asymmetry inherent in the clinical encounter, focusing on how differences in knowledge, language, time, authority, and existential vulnerability shape patient–physician interactions. Drawing on medical ethics, patient safety research, and sociotechnical perspectives on documentation, the text explores how well-intentioned clinical practice can nonetheless produce misunderstanding, documentation bias, and unrecognized harm.

Rather than proposing a comprehensive reform, the paper introduces a limited pilot concept: the voluntary presence of a neutral patient support person during selected clinical encounters, at the patient’s request. The proposal is framed explicitly as a hypothesis for exploration, not as a solution. The aim is to stimulate reflection and structured inquiry into how awareness of power asymmetry might improve understanding, psychological safety, and trust in clinical care.