BY Samuel Mathis, MD, Assistant Professor, UTMB
Recently, I have spent a significant amount of time helping a family member navigate the healthcare system. As the physician in the family, I’ve been on call during rounds, participated in family meetings, and even been present for resident and faculty evaluations while staying with the family members. This experience has been eye-opening for me to watch the various ways physicians interact with the patient and their family members. It has also been interesting to watch how some behaviors change when the physicians learn I am a physician who practices in the area. This interaction made me curious about what research is showing about the physician-patient relationship and how it may have changed since the pandemic.
The physician-patient relationship has been a focus of quality medical care since the time of Osler. Legally, cases going back to the 1800s show that there was an understood standard of engagement and care that physicians were expected to provide for their patients. A 2022 article in NEJM reviewed the historical changes in this relationship with a trend towards greater patient involvement and autonomy over their health decisions (1). The pandemic created a significant adjustment in this relationship as both in-person visits were replaced with telehealth visits, and the nuances of the relationship (facial expressions, touch, personal stories) took a backseat in the encounter. Reports now show that trust in physicians is waning, and we are losing our position as a trusted source of information regarding healthcare issues and concerns.
Why is the physician-patient relationship so important? The primary reason is that it improves the quality of care and the health of the patient. Studies have found that physician empathy plays a positive role in the health of their patients. Patients’ perception of an empathetic physician was noted to decrease the duration of cold and flu symptoms by up to a day. Additionally, empathy has been noted to improve the perception of care and how patients rate their physician’s ability and quality of care (2). Patients who trust their physicians are more likely to follow the directions and recommendations provided to them. Finally, patients with greater trust in their physicians are less likely to pursue litigation or file formal complaints when errors or bad outcomes occur in the treatment plan.
So, the question becomes, how can we rebuild the trust within the patient-physician relationship? One of the primary ways to gain trust is through empathic validation in communication. Within the exam room, this can occur through small gestures such as small talk before discussing health concerns or remembering to ask about a topic that was mentioned in a previous encounter. I personally use my EMR’s “sticky note” feature to remind me of a patient’s pet’s name or recent life event. If wearing a mask, try to be more expressive with your eyes and eyebrows to show interest or emotion. Finally, never forget the power of simple touch. One small habit I use is gently touching the patient’s shoulder as I point them toward the checkout counter at the end of the encounter. These small gestures are vital, especially when dealing with uncertain problems or concerns (3).
With the ever-increasing number of electronic communications physicians are asked to engage in with patients, smart phrases or A.I. technology can be helpful. Chat-GPT can write a very empathetic response to patients regarding their health condition. I then add a list of recommendations or encourage them to make an appointment at the end. A smart phrase in your EMR can start a conversation with the phrase, “I’m sorry to hear you are feeling bad.” This simple phrase can help patients feel heard regarding their concerns and more open to following the recommendations provided by their physician. Finally, providing simple reasoning regarding a decision can be incredibly helpful to ease patients’ emotions when not provided precisely what they are requesting. I regularly use the phrase “I want to ensure I have a full picture of what’s going on and that we are doing what is best for you” when recommending the patient come in for a visit.
The holiday season can be stressful for many people seeking medical care. Many times, people come to see us when they are feeling unwell or when they are having a significant concern regarding their health. We can help make their healthcare experience a positive one through simple acts to show that we care. I’ll leave you with this quote from the philosopher Seneca, “People pay the doctor for his trouble; for his kindness they still remain in his debt.”
References:
- Derse AR. The Physician-Patient Relationship. N Engl J Med. 2022 Aug 25;387(8):669-672. doi: 10.1056/NEJMp2201630. Epub 2022 Aug 20. PMID: 35984346.
- Wu Q, Jin Z, Wang P. The Relationship Between the Physician-Patient Relationship, Physician Empathy, and Patient Trust. J Gen Intern Med. 2022 May;37(6):1388-1393. doi: 10.1007/s11606-021-07008-9. Epub 2021 Aug 17. PMID: 34405348; PMCID: PMC9086002.
- Tietbohl CK. Empathic Validation in Physician-Patient Communication: An Approach to Conveying Empathy for Problems With Uncertain Solutions. Qual Health Res. 2022 Feb;32(3):413-425. doi: 10.1177/10497323211056312. Epub 2021 Dec 11. PMID: 34894864.