The doctor-patient relationship!

This article is contributed by Dr. Jayashankar to the ADK Hospital Newsletter, “TeamTalk” Issues 11 and 12. With his permission I share this on my Blog.

“You are feeling better today,” announced the Doctor, as he sat down by patient’s hospital bed.
Patient:  “Really? What’s better?”
“Well,” doctor sputtered, his face flushing, “in my professional opinion, you are better!”
Patient sighed, “ I don’t think so , I still feel the same, and tired “
Doctor:  “Your lymphocytes are better and you should feel  better.”
Patient stops reacting, unhappiness visible on his face.

Can you hear the tension in this encounter? Why are doctors and patients so often at odds? Why are both expressing more frustration and less satisfaction? To answer these questions, more and more researchers are putting the doctor-patient relationship under the microscope. What they are finding is fascinating!

The tug-of-war is because, doctors and patients are on different ends of the rope.

  • To the doctor, illness is a disease process that can be measured and understood through laboratory tests and clinical observations. To the patient, illness is a disrupted life.
  • The doctor’s focus is more on keeping up with the rapid advances in medical science than on trying to understand the patient’s feelings and concerns. Yet patient satisfaction comes primarily from a sense of being heard and understood.
  • Many doctors do not see the role of physician as listener, but instead view their function more as a human car mechanic: Find it and fix it. Yet patients often feel devalued when their illness is reduced to mechanical process.
  • Doctors feel frustrated, even betrayed, when patients withhold pertinent information. Yet patients who use alternative medicine, for example, may not tell their doctors for fear of ridicule or being labeled as Silly or uneducated.

Changes in our culture and in the practice of medicine have also added tension to the doctor-patient relationship. In some ways we have become more doctor dependent, because we see doctors sooner than people did 50 years ago, yet we are less dependent on the doctor for information and decision making.

All these changes are unsettling for both doctors and patients. Then there’s the blame factor. Doctors often blame patients when communication breaks down. But researchers have found that many doctors have shaky interviewing skills. For example,

  • Doctors do more talking than listening. A new study published this year in Journal of the American Medical Association (JAMA) found that 72% of the doctors interrupted the patient’s opening statement after an average of 23 seconds. Patients who were allowed to state their concerns without interruption used only an average of 6 more seconds.
  • Doctors often ignore the patient’s emotional health.
  • Doctors underestimate the amount of information patients want and overestimate how much they actually give. In one study of 20-minute office visits, doctors spent about 1 minute per visit informing patients but believed they were spending 9 minutes per visit doing so. 

Patients aren’t perfect either. In one survey doctors rated 15% of their patients as “difficult”. Disagreements involve everything from expecting an instant cure to demanding prescriptions. While one doctor’s difficult patient may be another doctor’s favorite, researchers have identified common characteristics of patients that everyone agrees are hard to manage.

Here are characteristics of patients described as “frustrating” by doctors

  • Do not trust or agree with the doctor.
  • Present too many problems for one visit.
  • Do not follow instructions.
  • Are demanding or controlling.

Patients who use the doctor as a scapegoat for their anger at the illness are less likely to get good care. “Doctors are profoundly influenced by the demeanor, comments, and attitudes of their patients.” A patient who is consistently rude and irritable will almost certainly not receive the same medical care as a patient who conveys more positive attitudes.

In spite of all these problems, there is reason for hope. Yes, doctors and patients will always be on opposite ends of the healthcare system, but that doesn’t mean they can’t pull in the same direction.

So what can the doctors do?

Cultivate a patient-centered partnership. “The patient desires to be known as a human being, not merely to be recognized as the outer wrappings for a disease”.

In a video-taped study of 171 office visits, doctors who encouraged patients to talk about psychosocial issues such as family and job had more satisfied patients and the visits were only an average of two minutes longer. Incidentally, doctors also benefit from the patient-centered approach, researchers note, because they feel more job satisfaction and are less likely to burn out.

  • To improve patient compliance, work on mutual trust. Research confirms that the health of the doctor-patient relationship is the best predictor of whether the patient will follow the doctor’s instructions and advice.
  • Respect patients as experts in the experience of illness. Patient-centered relationship that accepts the patient’s unique knowledge as just as important to outcome as the doctor’s scientific knowledge.
The medical visit is truly a meeting between experts.

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2 Comments on "The doctor-patient relationship!"

  1. britlin gino
    30/10/2011 at 09:14 Permalink

    patient centered care is important in eyery hospital,then only we can achive our common goals by gino(male nurse)i would like to thank affaal to publish this vauleable msg for us

  2. Dr Harihar khanal
    19/08/2016 at 15:04 Permalink

    Being a minutely analytical article ,it gave me a new insight. I am really enlightened by the facts described here which are around me for a long time but remained not carefully observed till now.

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