The Doctor Patient Relationship May Define Your Defense


Even as you strive to give the best care, your efforts may not be felt by the patient. This relationship is the heart of patient satisfaction with the physician, and the main catalyst of malpractice suits. Between all they don't know about medical care, the rush of modern practice, and the effects of illness, your efforts can seem detached to them.

There is much the patient feels and remebers that depends on basic human communication. Remember, this may be your 12th patient of the day but you are their first doctor. The patient sees you in terms they understand. On one hand this depends on whether you related to them, sympathized with them, and tried to take time with them. Did you try to understand their problem and how it affects them, even if they explained it badly?

The linchpin of the doctor-patient relationship is that they feel your concern, and that the communication is understood by both parties. You don't expect your patient to understand details and definitions on cardiac surgery or dermatology, but you do need for them to understand what it means to their life and what tradeoffs exist in their choices. But particularly they need to understand that you care, will act in their best interests, and be available. Aim for mutual respect and mutual trust. Avoid extremes of too little empathy or too much, or conclusions reached too quickly.

There is much about what the patient feels and remembers that depends on basic human biology of communication. This a complex relationship that affects care in ways that are as important and immutable as a disease process. Mastering it therefore provides a double benefit.

Here is a surprise: words account for only 7% of communication, voice 38%, and visual body language 55%. They say fundamentally liking is based on feeling, and this depends on the communication of both nonverbal and verbal means. Between being on a tight schedule and perhaps being tired, the tone of your voice and your body language may work against you, giving the wrong message.

Regarding verbal communication, be prepared to connect with the patient before you enter the room. It's better to enter an exam room with enough gleaned from the chart to know the patient, the problem and roughly where they stand.

This can be done in about a minute with most charts. Now, focused on them, you have established a relationship in the first sentence.

You appear engaged and in command. To go blindly into the meeting with the patient makes them feel less important, and wonder how much you really know.

They want to believe there's a personal relationship with you as well as a professional one. And they want to know that they are remembered as people. A little preparation will do a lot.

Maintain eye contact, address patients concerns as well as clinical points, and keep communication simple. Ask enough questions of them so that what you say is understood by them as closely as possible to the way you understand it. Bear in mind that patients often do not understand or even remember what they did understand. Also, physicians, in the patient's view, miss patient complaints and concerns, and even the key complaint, as much as 50% of the time.

What we say must make sense not only in the context of your meeting, but with meetings they have with other physicians or health-care providers, or alarms will ring. Disagreements will occur, but if you expect them, explain them. A worried patient is going to ask their friends and get other opinions. If there is an important factor in the decisions or an important risk indicator, it's better to mention it when you meet with them. This avoids puzzlement or loss of confidence when they find that out elsewhere.

Regarding nonverbal communication, it is said between two people, one will judge the other's personality in about 10 seconds, often by simple rules. So your first seconds with the patient are not a warm-up, but may be the key event. By habit, prepare for a few seconds before seeing them. It can help to ask a series of questions, after the initial encounter, in which the patient must answer yes. Thereby, setting a positive tone results in more effective communication. It's important to look at the patient steadily at times when key points are discussed. It doesn't mean that you can't be working on notes or typing on a computer, but you need to keep eye contact. .

Research has found that in order to convince the patient you are speaking to them, they need to be looking at you about 80% of the time and you need to be looking at them about 95% of the time. It may not be possible all the time, but do when communicating important points

If there is a bad outcome, don't avoid the patient, withdraw emotionally, or blame the patient. Recognize the problem, redouble your effort, and get appropriate notes and consultations in the chart. The likelihood of solving the problem to the best extent depends on your joint efforts and the patient's best compliance, and so does the likelihood of a suit.

Setting a positive tone and effective communication with the patients and you will get in return better outcome and compliance, and fewer complaints and litigations. Aim to maintain empathy and eye contact, while searching for important signals and signs. Identify the issues important to them. Teach the important points and negotiate for compliance in treatment. Encourage questions and verify their understanding.