It takes two
The text message read: “Thank you for the referral. I like his bedside manners and thoroughness. It is rare these days.” An octogenarian couple had sought my assistance as they had no regular physician in attendance. As a pediatrician, I am very much aware that my expertise in adult medicine needs fine tuning. Knowing how wary they were of hospitals and doctors, I had to find an appropriate fit. His last statement, however, left a lot of room for thought and reflection.
How is your relationship with your doctor? How many times have you shopped for one, hoping that there would be some sort of connection? Do you leave the clinic relieved or more anxious than when you entered it? What were the factors that made the experience pleasant or uncomfortable? As a physician, how often have you been complimented by a patient who says that the mere sight of you makes them feel better?
Establishing a harmonious, mutually respectful doctor-patient relationship can be quite challenging and requires effort from both ends. We have moved away from being passive recipients who unquestioningly receive a doctor’s advice on the premise that he knows best, to being active participants in the decision making process. Fortunately, I came across a study by Fuehrer et al., enumerating approaches utilized by highly skilled primary physicians to help build rapport and establish a relationship. While the study acknowledged that the communication skills mentioned were identified in prior studies, what made it different was the value of being authentic in employing these techniques. From experience, there will always be possible and real friction points that will require skillful navigation, anchored on remembering what we promised to adhere to as doctors. The ability to be honest and real goes a long way in helping build trust and effectively connect with one another.
First, “respect the patient as a whole person who has their own set of beliefs, values, personal experiences, and perspectives.” This is the foundation of any relationship. To be able to identify what is important to them and to truly understand their perspective, especially in a situation where their final decision might not be in line with your recommendations is crucial. While this may not be the norm in our country, in such an instance, the doctor needs to let the patient know that he will still be cared for.
Second, be genuinely curious about your patient’s story. While obtaining a good clinical history plays a major role in the diagnosis, subsequent management and care of a patient and the ability to empathize with a patient help cultivate stronger connections.
Third, employ focused listening. Avoid distraction. Far too often, the mind races on to the next step to be done. While this is an integral part of the whole process of diagnosing a condition, we have to consciously pull back, be present, and be engaged. Sometimes it’s better to just listen and give them time to relay their story rather than interrupt. Eye contact and body language go a long way in conveying that you are hearing what they are saying.
Fourth, mutual participation. This should be encouraged. Our role primarily involves sharing medical expertise. Once the plan is mapped out and discussed thoroughly, we have to remind ourselves that the patient always has the final word. While this may be viewed as collaborative, the end goal should be to empower the patient to take charge of his own health.
Fifth, self awareness. As physicians, we have to be able to verbalize how we are connecting with our patients. The ability to reflect and analyze impacts on our medical decision-making and well-being.
These techniques are ideally to be followed to help build an authentic doctor patient relationship and also serve as timely reminders for self improvement. However, while the capacity to understand and empathize may seem to be dependent on the attending physician, to a certain extent, the same is expected from the patient who needs to recognize where his doctor is coming from. It always takes two.
So how and where do we begin? For starters, we should both strive to be on neutral ground and respectful of each other’s individuality, boundaries, and limitations. For patients, it is important to clearly express your expectations from the start so that your doctor is well aware. Armed with this knowledge, it helps guide and encourage him to find the ways to meet them whether it takes the form of allotting more time for a clinical encounter, giving you the freedom to ask more questions, and providing a safe space for your concerns to be heard. Both parties need to work at an open type of communication, which hopefully would be able to pave the way for a more authentic doctor patient relationship.
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