Medicine is often about the human interaction that occurs between the physician and the patient. It is in that interaction that physicians are able to gain the trust that allows their patients to discuss the information that is needed to make accurate diagnoses. And it is in that very same relationship that we are able to engage our patients to follow treatment plans that ultimately result in their improved health and quality of life, even if the initial therapy does not work out as planned. Thus, it allows us to build the trusting relationships that allow us to be imperfect, as we all are, in our pursuit of successful therapeutic answers for our patients.
Unlike other relationships, the physician-patient relationship is often forged in the setting of major life events such as births, severe illnesses, and death. As a result, some relationships tend to develop rapidly over short periods of time. For example, the first patient of mine who passed away did so during 1 of my first 30-hour shifts as an intern.
I got called down to the emergency department to admit her to the medical intensive care unit (MICU) for fever, tachycardia, and hypotension; she was in septic shock. She had previously been admitted to a nearby hospital for 2 weeks for diabetic complications and sepsis. Despite being discharged only a few days before, her family reported she had never improved and appeared to be getting worse.
When I went down to examine her, we found a central line buried within a large neck abscess from the prior admission. I spent hours talking to her and her family and immediately began to form bonds with them. By explaining to them what was going on and how we planned to treat her, I was able to build their trust and confidence. In return, they shared some startling and helpful information about her prior hospital admission that helped guide her therapy more appropriately.
When things deteriorated later that morning, I kept the family informed. When she finally passed away, despite our best efforts, I was devastated. To make matters worse, my ignorance on dealing with such matters led me to believe that I would be met with anger and hostility. Instead, I found compassion and appreciation for the care I had provided her. In a matter of hours, I had gone from being a complete stranger to this family to sharing one of their most painful and tragic moments.
Luckily, not all relationships end so tragically. As physicians, we have the unique opportunity to develop bonds with our patients over years, and in some cases, even decades. It is ironic, then, that I often see my trainees and colleagues describing patients by their disease. The key to a successful physician-patient relationship, in my opinion, is to recognize that the patient is not the disease being treated. They are human beings who often need us to listen and understand how the disease they are battling affects their day-to-day lives.1 They need us to care about what happens to them. Most of all, patients need us to show empathy toward their plight.
Despite the shift in focus to patient-centered care by nearly all US medical schools, the ever-changing landscape of healthcare threatens our ability to listen well. Newer healthcare models aiming to control costs and make the delivery of care more efficient have also introduced varying organizational and financial scenarios that are often difficult for patients to navigate.2 Changes in how we document, how we bill, and the ever-growing financial and administrative burdens of this brave new world of medicine no doubt impede our ability to successfully build trusting relationships.3
Further, we are constantly under time constraints or being interrupted about the plethora of other issues surrounding our practices. I, for example, am currently developing both a heart failure program and chest pain pathway.
As a result, I will often get interrupted while with my patients to provide guidance to other clinicians or nurses facing complicated patients presenting with worsening heart failure or chest pain. When I do have to step away or take a call, I always try to make the time up to my patient, and I always show appreciation for their time by apologizing for the interruption. Although this may seem trivial, it is often not done, which as a result, leaves patients with negative impressions of their physicians.
By far the most important aspect of a good physician-patient relationship is communication.4 Whenever possible, I try to talk to my patients as I would a family member or a friend. When I need to make a point, I do not shy away from using personal and/or anecdotal experiences to help drive it home, and rarely do I avoid using humor when appropriate. Given the nature of cardiology, patients often walk into my office very seriously and worried. A little humor can go a long way in helping them feel more relaxed and ready to share their concerns or partake in therapeutic plans.
The second most important feature of a good relationship involves how we make decisions. I often share with my patients the research and guidelines from which I am basing my therapeutic recommendations. I always try my best to make it more understandable, despite variable levels of education, and whenever possible, I draw them diagrams or search for illustrations to help solidify the point.
However, even when they do not understand what I’m explaining, I have found that the mere fact that I took the time to try to explain it to them enhances the trust and confidence they have in me. Further, disclosing what we physicians do not know is equally as important. Physicians notoriously have a hard time admitting that they do not know the answer to a problem, yet much of what we do comes from incomplete research, consensus statements, and pattern recognition from prior experiences.
The truth is, we really do not always have a well-established, evidence-based solution to the problem we are trying to solve. For example, diastolic heart failure remains one of the most difficult and poorly understood conditions to treat. Nearly every clinical trial exploring potential interventions has been negative. Thus, when I discuss medical therapy with my patients, I tell them upfront, “these are the best options we have based on what we do know,” and that they may not work. I discuss the risks, benefits, and alternatives, and I share the decision making with them.
I avoid dumping the final decision on them; rather, I guide them by listening to their concerns, sharing my concerns, and negotiating a plan aimed at improving their well-being. I rarely offer any guarantees, but I offer support, guidance, and an unrelenting promise to work with them until we find a solution that works. That builds both trust and respect, especially when therapeutic interventions fail and alternative therapies need to be proposed. Without the valuable and instrumental trust that develops in a healthy physician-patient relationship, patients may seek care elsewhere or, worse, give up on their own care and suffer poor outcomes.
- Rettner R. Does your doctor need to show more empathy? LiveScience. Updated December 7, 2016. Accessed September 12, 2017.
- Rosser W. The benefits of a trusting physician-patient relationship. Fam Pract. 2001;50:329-330.
- Ofri D. The doctor-patient relationship is alive and well. New York Times. Updated July 13, 2016. Accessed September 12, 2017.
- Goold S and Lipkin M. The doctor-patient relationship. J Gen Intern Med. 1999;14:S26-S33.
This article originally appeared on Medical Bag