The Patient and the Physician

January 9, 2019

Every repeated interaction between two individuals is a relationship. For physicians and patients alike, it is crucial to establish transparency and respect between both parties.

  • As a patient, you should be comfortable that your physician has the knowledge, experience and skills needed to diagnose and treat you, AND that there is a personality fit between the two of you.
  • As a physician, you need to feel comfortable that you have the knowledge, skills experience AND are able to give sufficient time and attention to your patients to be able to provide appropriate care to them.


Given those perspectives, here are some thoughts to consider:


Patients
Being a savvy patient can help make the whole experience better. The days of assuming that “the doctor knows best” and being a completely passive patient are behind us. It is important to know your health history as well as that of your family before you see a new physician and to understand why you are seeing this particular doctor, even if it is just because another doctor referred you due to particular test results. If you have complex health issues, a private professional Health Advocate (sometimes called a Patient Advocate) such as someone from HealthACR, will be able to help you navigate through the confusion and make sure that the right questions are asked and answered.

  • Physician office visits often feel rushed, causing patients to feel increasingly nervous and to forget to ask important questions and relay information. Physicians who look at computer screens during the visit without making eye contact exacerbate the situation, fail to establish or maintain a relationship based on trust, and may miss important information and non-verbal signals. The quality of physician-patient relationship is the key to reducing the likelihood of litigation.¹
  • There are many situations in which seeking a second opinion from another qualified physician makes sense before making a decision regarding the next step in treatment. There is absolutely nothing wrong with seeking a second opinion. In fact, a good physician should encourage you to do so and is probably sought after as a source of second opinions as well. Insurance plans should be willing to cover payment for a second opinion. Any physician who discourages a second opinion should immediately raise  a red flag.
  • Another reason for seeking out another provider may be that, as the patient, you do not feel that there is a good personality fit between you and the first provider you are seeing. Again, which provider you work with is up to you (as long as the provider is accepting patients) and is very important, especially if you will be going through arduous treatment for a difficult diagnosis. It is a separate consideration from whether your insurance will pay for that provider, though that, too, is an important factor. It is important to choose a provider/team with whom you, and hopefully your family or other support systems, feel comfortable. This will reduce your levels of anxiety and increase the probability that you hear and comprehend what you are supposed to do during your treatment. Compliance with treatment protocols is critical to successful outcomes.²
  • Talking to a physician and asking questions will get you far along the right path to clarity and a successful patient-physician relationship. Questions not only help you get what you want, but they also help your physician see from your perspective. Your physician can then proceed from there, knowing your biggest concerns. The trick is to formulate and ask the right questions. The Agency for Healthcare Research and Quality provides numerous questions for various situations.³

Talking to a physician and asking questions will get you far along the right path to clarity and a successful patient-physician relationship. Questions not only help you get what you want, but they also help your physician see from your perspective. Your physician can then proceed from there, knowing your biggest concerns. The trick is to formulate and ask the right questions. The Agency for Healthcare Research and Quality provides numerous questions for various situations.

Physicians
Physicians are frequently frustrated by the increasing amount of bureaucracy required by insurance companies and the lack of time they get to spend with their patients. That is one of the many reasons why some have chosen to work for hospital-owned practices where the hospitals take on the administrative work of filing claims, billing, and account receivable, as well as managing the office functions. That said, there are many things that the physicians should do regarding their own behavior to improve the patient-physician relationship that fall within their control:

  • Pressure to see many patients in a short period of time can increase physician stress levels and decrease their perceived empathy towards their patents. As a physician, asking questions is often part of the job and, if done correctly, especially with eye contact, can go a long way towards establishing a relationship. One could go the less technical route and start, or conclude the visit, with a simple question such as “What are your goals?”, as suggested by Dr. Suneel Dhand⁴. An open-ended question like this can in fact pull useful information both for you and your patient. Because this question goes beyond typical physician-to-patient etiquette, it sends a strong message that the patient is the priority.
  • On the topic of etiquette, when consulting with a patient, non-verbal mannerisms are just as important as verbal ones, if not more. From the way we look to the way we move, a physician’s mannerisms can impact the patient’s level of anxiety. Verbal etiquette can significantly improve a patient’s experience. Some examples would be to allocate uninterrupted time, engage with eye contact, and wrap up the end concisely⁵. It may seem straightforward, but doing so actively and without split attention is the trickier part, and when done successfully, can make a patient feel well attended to. Not staring at the computer screen, or even apologizing for the fact that you have to do so for part of the time, will go a long way with most patients. Using gentle verbiage and open ended questions will encourage patient responses whereas brusque or rude phrases may make patients shut down and be less responsive.r
  • Having a relationship with a patient based on open communication is good for the patient’s well being and dramatically reduces the likeliness of being sued⁶ should anything go wrong, not just because a positive relationship builds trust, but also because it provides transparency and ground rules. Patients want to feel that they are heard and that their physician is both physically and emotionally present and attentive to their needs. This should include easy questions and more difficult ones. For instance, asking your patient the question on how to proceed, should life-threatening situations occur, and having a discussion about why this is important and what the question means can show that you care about your patient. It is also an important step that will benefit the patient, their families and their providers should anything happen to them in the future that requires that someone else make decisions on their behalf regarding their care.⁷
  • Own your mistakes, including apologizing if you run late. Sometimes, in the world of medicine, emergencies arise or patients do need more time than was anticipated. It is important to apologize to your patients if you are late, if you mispronounce their names or discover that someone in the office made a mistake or that the patient even perceives a mistake, whether or not it happened. Maintaining a good relationship is much more important than always being right when the issue at hand is not important.
  • Look for opportunities to help your patients feel that they have some control over what is happening with their treatment. Patients who face complex diagnoses and treatment plans usually struggle with anxiety and the feeling of a lack of control over what is happening with their health. In discussing treatment plan options, even day to day activities or other decisions, look for opportunities to give them a sense of control, for example, giving them decision power whenever possible. It is important to recognize the psychological components of complex medical issues, especially those associated with depression and anxiety.

¹ Carroll, A. E. (2015, June 1). To Be Sued Less, Doctors Should Consider Talking to Patients More. The New York Times.
² Masters, P. A. (2018, November 6). Why patients don’t do what physicians tell them. KevinMD.
³ Questions To Ask Your Doctor. (n.d.).
⁴ Dhand, S. (2018, July 29). The simple, powerful question doctors should ask their patients. KevinMD
⁵ Dhand, S. (2018, September 23). How to make the most of rushed physician visits. KevinMD.
⁶ Carroll, A. E. (2015, June 1). To Be Sued Less, Doctors Should Consider Talking to Patients More. The New York Times.
⁷ Verma, V. (2018, November 7). Have difficult conversations now to avoid chaos later. KevinMD.

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