A Shared Pressure Point in Modern Care
This article is part of a series
by Dr Sasha Nair, Endocrinologist
On Moving Ground: Shifts in Medicine and Culture
examining the patterns emerging across medicine and culture.
25/02/26
Healthcare doesn’t stand still. And it rarely changes in straight lines.
Ideas gather momentum. Conversations widen. Priorities shift — sometimes gradually, sometimes seemingly all at once. What appears sudden has often been building quietly under the surface.
After two decades in clinical practice, I’ve come to recognise the rhythm. Disruption is often followed by a period of significant — and entirely understandable — struggle, before a new equilibrium begins to form. We have seen how profoundly a global event can reshape practice and culture, leaving us altered in ways that are intensely difficult, while also accelerating changes that may strengthen aspects of practice for years to come.
But adjustment doesn’t always arrive abruptly. Sometimes it unfolds as a slow drift — shaped by accumulating tension, shifting pressures, and the subtle adaptations of the people responding to them.
In On Moving Ground: Shifts in Medicine and Culture, we’ll explore these wider currents — how medical practice is shaped not only by evidence, but also by culture, policy, technology and expectation.
Sometimes we’ll pause and step back. Other times we’ll zoom out to a wider vantage point — watching how the dots begin to gather, how patterns take shape, and asking, together, what they might be pointing toward.
Not to prescribe conclusions.
But to notice what is moving — and how our responses could shape what comes next.
In This Series:
- Cultural Shifts in the Modern Doctor’s Appointment: A Shared Pressure Point in Modern Care
How expectations, vulnerability, time pressure and information access have subtly reshaped the clinical encounter. - The Menopause Moment: From Silence to Surge — and Where the Wider Health Arc Points Next
Why menopause has become a defining cultural conversation, how other health movements signal its likely next phase, and how these overlapping trends shape the direction the conversation may take. - When Medical Conversations Speed Up: Media, Advocacy and the Compression of Nuance
Why modern health debates move faster than evidence generation — and how amplification changes the tempo of trust. - Staying Oriented in a Fast-Moving World: How to Navigate Rapid Change
How clinicians and healthcare users can remain broadly informed about AI, scientific change and world events through overview and pattern recognition rather than constant real-time consumption. - PMS and PMDD: An Upcoming Cultural Inflection Point?
Why premenstrual disorders may be entering a new phase of visibility — and how their clinical realities differ in important ways from menopause. - Influencing the Direction of the Swing: The Shared Role of Clinicians and Healthcare Users
If medical conversations move in cycles and surges, how both healthcare professionals and the public shape where they ultimately settle.
Cultural Shifts in the Modern Doctor’s Appointment
A Shared Pressure Point in Modern Care
There was a time — not so long ago — when the medical consultation unfolded within a certain type of hierarchy.
Picture a typical appointment in the 1980s or 1990s. A doctor in a white coat might ask direct questions, deliver a diagnosis succinctly, outline a treatment plan and then move to actioning that plan. There may not have been a lot of discussion of different options, grey zones, uncertainty, or the emotional dimensions of illness.
It wasn’t necessarily warmer.
It was not necessarily better.
But expectations on both sides were simpler.
Roles were more clearly defined, and doctors opinions were less often negotiated in the room. The consultation began with a shared assumption about how authority and responsibility would operate.
Today, that starting point is less defined.
Patients still arrive with lived experience — they always have. But they now also arrive having done online research, attended prior consultations, absorbed community and social media narratives, and developed stronger expectations of participation in decision-making.
Hope and caution often coexist.
Hope that this clinician will listen, explain and help.
Caution shaped by previous experiences that did not feel steady.
And it is precisely because of this hope that disappointment can feel so sharp when something lands differently than expected.
The consultation no longer begins from a single shared assumption. It begins in a more complex space.
And that shift matters.
Rising Expectations — on Both Sides
Modern clinicians are often expected to:
- Practise evidence-based medicine while accommodating individual preference.
- Deliver clinical excellence — while being prepared to discuss experimental or unsubstantiated tests and treatments.
- Be professional whilst providing emotional affirmation and reassurance.
- Offer multiple options.
- Guide toward the most appropriate option— without appearing pushy
- Be explanatory and accessible.
- Avoid appearing financially motivated.
At the same time, patients are navigating their own pressures.
They may have:
- Waited months.
- Paid significant fees.
- Spent hours researching symptoms.
- Read worst-case narratives online.
- Been told to “advocate harder” for themselves
- Been told they are “overthinking.”
By the time they enter the room, the consultation carries weight.
It may represent hope.
Validation.
Relief.
Or it may feel like another attempt after previous disappointments.
This emotional load is often invisible — to both parties.
Medicine also still carries a particular sensitivity around money. There remains a quiet cultural expectation by many that doctors should be motivated purely by goodwill, and should not appear concerned with compensation, that care should be offered out of the goodness of one’s heart, rather than as professional expertise delivered within a structured service.
Long before a consultation begins, a doctor has invested years of study and significant financial cost. Each appointment also sits within overheads, regulation, administrative follow-up and medico-legal accountability.
Compassion, professionalism and fair compensation are not in opposition and are not mutually exclusive.
From a patient perspective, paying while feeling vulnerable can heighten sensitivity. Financial exchange amplifies the stakes:
If I am paying for this, it needs to matter.
I need to make sure I’m getting value.
But what constitutes providing value is, from the doctors perspective, not always predictable. In addition to sound medical care, for some patients, it is time and unhurried space. For others, efficiency and getting things done in fewer appointments. For others still, it is more detailed explanation, reassurance, more investigations than is routine, decisiveness, symptom relief — or simply feeling heard.
From a clinician’s perspective, much of the work is cognitive: analysing information, weighing risk, exercising judgement. Those decisions carry responsibility long after the appointment ends.
Even when both sides understand this, the stakes can feel high.
When Efficiency Is Misread
In most professions, efficiency signals mastery.
In medicine, efficiency can feel different — particularly for someone who has felt unheard before.
An experienced clinician may synthesise complex information rapidly, identify the core issue early, prioritise accurately and deliver a plan succinctly. From the inside, this reflects pattern recognition developed over years. From the outside, it can feel compressed.
Patients can tend to see minutes.
They may not necessarily see the years behind those minutes.
Time is often used as a proxy for value. Yet duration in the room does not necessarily reflect depth of assessment. Experienced clinicians may be able to recognise patterns quickly, reducing unnecessary steps and avoidable investigations.
What appears brief may still be thorough.
In primary care, structured appointment times add further pressure. A ten-minute consultation may need to prioritise one (or even part of one) issue safely rather than addressing several superficially. Redirecting multiple or complex issues to be managed over multiple appointments can be interpreted as obstructive, particularly when the patient hoped everything could be resolved at once.
Here, perception and intention can diverge.
The clinician may be thinking about safety, cognitive load and fairness to the next patient.
The patient may be thinking about access, cost and the effort of getting to the appointment.
In that space — where vulnerability and responsibility meet under time pressure — neutral behaviours can be interpreted in very different ways:
- Efficient questioning → “She’s rushing.”
- Clear boundary → “He doesn’t care.”
- Calm affect → “She’s detached.”
- Declining a non-validated test → “She’s dismissing me.”
At times, an interaction may feel unsettled even when the clinical reasoning is sound. That does not automatically mean someone has done something wrong. It reflects the complexity of modern consultations.
For doctors, it can help to set priorities early — agreeing which issue will be addressed in depth today, and how others might be managed in stages.
For patients, it can help to name what matters most — while recognising that complex or multiple concerns may require more than one appointment to address.
Small moments of clarity create firmer ground.
When the Consultation Begins Mid-Story
(Complex consultations and accumulated history)
Some consultations do not begin at a neutral baseline.
The patient may have had multiple prior opinions, tests, referrals and attempts to find an answer.
Those with long-standing or difficult-to-categorise symptoms may arrive already carrying disappointment.
They may have:
- Left earlier appointments still unsure what was causing their symptoms.
- Been told tests were “normal” without understanding why they still felt unwell.
- Experienced explanations as minimising.
- Invested time and money pursuing alternative pathways.
- Seen several clinicians without finding clarity.
By the time they meet someone new, it is difficult to be neutral.
They may be scanning.
For tone.
For subtle cues.
For whether they are believed.
This is rarely hostility. It is more often caution.
The doctor in the room today was not present for those earlier encounters — yet expectations of this consultation may still be shaped by them.
History increases interpretive sensitivity.
A neutral comment may carry weight.
A brief answer may feel loaded.
Not always because of what is said.
But because of what has unfolded before.
The past does not need to be erased.
But it helps to recognise when it is influencing how the present is read -for both parties.
The Automaton vs Human Paradox
Modern medicine operates within a quiet contradiction.
Doctors are expected to function like infrastructure —consistently available, diagnostically accurate, responsive to results and messages, rarely cancelling, maintaining continuity without interruption and without error.
At the same time, they are expected to be fully human in the consultation.
Warm.
Fully present.
Emotionally attuned.
Unhurried.
The expectation is constant function and constant empathy.
But the truth is, clinicians are not infrastructure. They are people.
They have health problems of their own.
They have families and competing commitments.
They experience fatigue and, at times, burnout.
They make judgement calls about when they are fit to work.
When an appointment is cancelled or delayed, it can feel destabilising — particularly for a patient who has already experienced inconsistency.
Yet sustained clinical performance and emotional presence require limits.
Boundaries are not indifference.
They are what make good care sustainable.
From Shift-Based Medicine to Always-On Medicine
In acute hospital work, responsibility is often shift-based. The work can be intense, physically demanding and high-stress — but it is time-bound. When the shift ends, care transfers to another team.
Outpatient practice carries different pressures.
Results arrive between appointments. Messages accumulate. Patients may see reports online before discussion, or expect contact once a test is completed.
For patients, this can mean waiting with unanswered questions.
For clinicians, it can mean carrying unfinished threads beyond the consultation itself.
The intensity may be lower than acute care.
But the exposure is more continuous.
Hospital walls once created natural stopping points.
Modern outpatient practice requires those stopping points to be intentional.
Clear response windows, protected administrative time and agreed expectations around follow-up help prevent low-grade vigilance from becoming the norm.
Containment is no longer structural.
It has to be intentionally designed.
A Cultural Inflection Point
These shifts are not individual failings. They are structural and cultural.
Information is now instantaneous.
Interpretation is now public.
Expectations are higher.
The medical consultation is no longer a contained exchange between two people.
It sits inside an ecosystem of online narratives, economic pressure, workforce strain and heightened awareness of power.
If practice doesn’t evolve, strain accumulates — as burnout on one side and mistrust on the other.
The future of modern medicine is unlikely to be a return to hierarchy.
Nor is it sustainable to promise unlimited clinician accommodation.
Through increased awareness on all sides, what may emerge instead is something more defined:
Boundaries that are visible and held.
Expectations that are mutual rather than assumed.
A shared understanding that uncertainty is often part of real clinical work — that symptoms do not always map neatly to tests, that evidence evolves, and that not every question has an immediate or definitive answer — and that meaningful improvement is sometimes incremental rather than dramatic.
Not to make medicine colder.
But to make it workable and sustainable.
If decision-making is increasingly shared, then responsibility for how consultations unfold needs to be shared as well.
This cultural arc is not towards certainty.
It is towards better alignment between what medicine can realistically offer — and what patients reasonably hope for.
That alignment will determine whether sustainability of and trust in healthcare strengthens or erodes in the years ahead.
In the On Moving Ground: Shifts in Medicine and Culture series, Dr Sasha Nair, Endocrinologist, co-founder of ERH Associates and Certified High Performance Coach (High Performance Institute), draws together clinical experience and behavioural insights to contextualise shifts in contemporary medical practice within its wider cultural dynamics.
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