Rekindling the Doctor-Patient
Relationship
The joy of practice is two-fold: Intellectual
and Relational.
The intellectual side of us thrives on the
challenge of complex medical decisionmaking
and computational fact-finding. Understanding
and applying pathophysiology
is what we trained for, and what most of us consider to be a
joyful brain exercise.
However, since we do not practice medicine in a vacuum,
the relational side of patient care is equally important to job satisfaction.
It is, without doubt, the more challenging and frustrating
part of practice. The desire to provide “care” to those in
need was, for most of us, an overwhelming reason for entering
the medical field. Yet, we had little training and preparation
for just how to go about this in the most productive way.
The extensive demands on our time make this task even
more difficult. The emotional drain of “difficult patients,” “difficult
colleagues,” and a dysfunctional healthcare system add
to the burden. However, if we don’t find ways to produce positive
relational encounters with our patients, we will find ourselves
feeling half-empty of the joy of practice.
I’d like to share a few methods I have learned over the
years that will enhance your patient relationships, ensure
positive patient encounters, and, subsequently, support
years of joyful practice.
We all know that a positive doctor-patient relationship is
built on trust. In urgent care it is very difficult to build trust
with a patient we don’t know in the 10 minutes we have per
encounter. It is critical to understand, however, that trust between
patient and doctor determines every outcome from
that encounter. Trust ensures compliance, risk management,
patient satisfaction, and perception of quality. Trust
also ensures that the physician gets accurate and useful information
which he/she uses to provide optimal clinical
care. Additionally, trust ensures an efficient patient encounter,
a much overlooked fact.
So what builds trust? Empathy. Patients want you to make
them feel like you care.
Take, for example, the hysterical patient, a challenging and
emotionally draining encounter for most.
Ask yourself: “What is it that this patient needs?” Answer:
Attention.
“Why is this patient screaming so loudly?” Answer: Because
no one will listen to them.
Despite gut tendencies to react otherwise, give this patient
a little attention and let them know you “hear” them. Consider
saying this: “Wow, that must make it really difficult to get out
of bed in the morning.” Nothing changes the tone of this type
of encounter faster. Patients invariably cooperate and let you
control the rest of the encounter. End result: Quality, efficient
care without the emotional strain.
Consider the mother of three with four days of a flu-like illness.
Most physicians will assume she is just here for an antibiotic.
If I give her an antibiotic, she’ll be happy; if I don’t, she’ll
be angry.
There are two things at play here: “Caregiver” as “patient”
and an underestimation of the severity of influenza. Let her
know how awful the flu is. Show lots of empathy. Then give her
permission to be the patient for once. “You can’t always be the
caregiver.” You will be surprised how many leave grateful,
with no antibiotic at all.
So what undermines trust? Judgements. Remember, patients
come to the doctor to be cared for, not judged.
I will address common scenarios that lead to dangerous and
inaccurate judgements in a future column. Until then, lay your
hand on a patient’s shoulder, look them in the eye and say, “I
am sorry that you’ve had to go through this,” and see how it
changes your day.
Lee A. Resnick, MD
Editor-in-Chief
The Journal of Urgent Care MedicineTM
President UCAOA
