Some Thoughts on the Patient-Doctor Relationship

25 Feb

There is an inherent power differential in the patient-doctor relationship: The patient comes to the doctor as an authority on his/her physical or emotional state and is thus either intellectually or emotionally dependent on the doctor’s treatment plan and advice. It is therefore absolutely essential that the doctor respect the patient as an equal participant in the treatment. Although the doctor certainly has knowledge about how similar conditions were successfully treated in the past, hopefully a medical professional will display an attitude of respect and mutual collaboration with the patient to resolve his/her problem.

Listening is a key component of conveying an attitude of respect toward the patient. Nowadays practitioners are most often taking notes at their computers while speaking with the patient. This is certainly time-efficient and may in fact be necessary in order for a medical practice to remain solvent with the demands of insurance companies and CMS. However, multitasking does not convey to the patient that s/he is connecting with the doctor. Listening is a complex action which not only involves the ears, but the eyes, the kinesthetic responses of the whole body and attention to the patient’s nonverbal communication.

Some of the key faux pas to avoid when listening to the patient include:

• Not centering oneself before engaging in a “crucial conversation”
• Not listening because one is thinking ahead to his/her own response
• Not maintaining eye contact
• Not being aware of when one feels challenged and/or defensive
• Discouraging the patient from contributing his/her own ideas
• Not allowing the patient to give feedback on what s/he heard as instructions
• Taking phone calls or allowing interruptions during a consultation

It is always helpful to give a patient clear, written instructions about medications, diet, exercise, etc., which result from the consultation. Some doctors send this report via secure e-mail to the patient for review, which is an excellent technique.

The art of apology is another topic which greatly impacts the doctor-patient relationship, as well as the doctor’s relationship with the patient’s family members. In my book, Soft Skills for Tough Issues: Fostering Interpersonal Communication in the Workplace, I note that this art is a “process that has recently emerged in the medical and medical insurance industries.” Kaiser Permanente’s director of medical-legal affairs has adopted the practice of asking permission to videotape the actual conversation in which a physician apologizes to a patient for a mistake in a procedure. These conversations are meant to help medical professionals learn how to admit mistakes and ask for forgiveness. Oftentimes patients are looking for just such a communication, which may allow them to put to rest feelings of resentment, bitterness and regret. Our patients’ well-being is our ideal goal. Knowing that they have been heard and their feelings understood may in the long run allow patients and their families to heal mind/body/soul more powerfully than we had ever thought. Of course, in our litigious society this may well be an art that remains to be developed over the long term.

Note: Jean Eva Thumm is a licensed Marriage and Family Therapist in New Mexico and in Delaware. She works with people from all walks of life, including professionals from a variety of fields. As a Management and Employee Assistance Professional, she has conducted numerous mediations, seminars and Critical Incident Stress Debriefings.

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