It is not uncommon for patients to be afraid to tell their doctors the truth.
Maybe it is about drug and alcohol use, sexual concerns or other problems: not getting the prescription filled when they didn’t have the money, or simply forgetting; having the medication but not taking it, or not liking how they felt after taking it; not wanting to try an alternative to a desired medication that the doctor felt was potentially addictive; fear of the doctor’s possible anger or disappointment.
The bottom line is that the physician will have no idea why the treatment failed and the patient didn’t progress.
On the flip side, a positive, caring and trusting relationship allows the patient to give his or her doctor the whole story, even if it isn’t pretty. If the patient trusts the doctor enough to share hidden concerns about what caused the problem, the doctor will be far better equipped to help.
A strong, healthy doctor-patient relationship is still vulnerable to bumps in the road or flaws in both individuals, but is likely to weather them. Neither party wants to let small imperfections get in the way as long as it is clear you’re working as a team for the benefit of the patient’s health.
If the doctor runs late but the patient knows the physician will provide the full attention and care needed, the patient will generally overlook the lateness. The physician may make a mistake, admit the error and express true remorse. Patients are grateful for the honesty and don’t want to lose their connection for care.
Given the importance of the doctor-patient relationship, medical schools spend a lot of time helping students learn to develop the skills necessary to create successful relationships with their patients.
Doctor Shadowing
Observant students who have witnessed such doctor-patient interactions when shadowing doctors frequently write about them in their med school application essays. One of the truly great physicians and teachers, Dr. William Osler, said: “Listen to the patient. He is telling you the diagnosis.” If you have shadowed, you may have watched this unfold in real time. Active listening, eye contact and expressions of empathy are key.
During the coronavirus pandemic, most shadowing had to be shifted to a virtual format, which is better than nothing but not as helpful as actually being involved in the experience. Students should start seeking shadowing opportunities early in med school so that they can observe many different specialties and not wait until clinical clerkships begin.
[Read: What Medical School Hopefuls Should Know About Types of Doctors.]
Ask the student affairs dean, your adviser or a fourth-year student for suggestions about who to contact about shadowing. For doctors who see patients only briefly, how do they accomplish building a bond with their patients? Ask them about the challenges of trying to build a new relationship.
The more different experiences you have with diverse specialties, the easier it will be to make up your mind about what is right for you when the time comes.
Med School Curriculum and Clinical Clerkships
The standard med school curriculum will have built-in communications classes with standardized patients who are actors. This is very different from shadowing with physicians on the job and real patients. Standardized patients are coached to represent patients with particular conditions, moods or personality characteristics.
This experience is set up to let you feel what it would be like if you were taking care of the patient yourself. You may get the opportunity to build a relationship, then have to tell the patient there was an omission or error that occurred in his or her care. How will you approach the standardized patient who has a terminal illness? There is much to learn about relationship-building during med school.
From outpatient clinics and teaching patients how to prevent illness to acute emergency care for a patient newly admitted to the hospital, you will have guidance and time to ask questions of your preceptors about the strengths and challenges of the doctor-patient relationship. Many of these occur during the clinical clerkship year beginning the second half of year two or the beginning of year three.
How does the physician review the chart before going in to meet the patient? The more the doctor understands the purpose of the visit and what information the patient has already divulged, the better. The chart helps the physician understand how the patient has dealt with a health concern and what limitations to life the patient has experienced.
Do you recall a time when a doctor interviewed you without checking your medical chart or reading your application? It can feel like you are not important enough for him or her to take the time to get to know you. That’s not a good way to build a relationship. The patient may feel the doctor doesn’t care enough to understand what the patient has been through in the past.
By careful observation, we can learn better ways to begin a relationship and improve those that are less than optimal. Watch carefully how doctors greet patients. Do they express warmth or show evidence of true caring? How do they ask questions that allow patients to tell their story, as Osler recommended?
A patient does not want to be interrupted while sharing with the medical team, but the individual may have trouble organizing the story in a meaningful way. How does the doctor let the patient know respectfully that what the patient is sharing is important and that the health care team wants to hear that information, as well as some other facts or additional discussion about a related topic? How doctors shift topics can help or hinder relationship-building.
[Read: 4 Skills Every Premed Student Should Develop Before Medical School]
Look for ways a physician shows respect during a patient’s physical examination by what the doctor says and does. Consider how the physician frames the information so that the patient can understand. Finding out what the patient fears and exploring what he or she anticipates is critical before discussing a serious diagnosis.
Gentleness in answering questions and patience with the individual’s concerns are critical for the doctor to gain the patient’s trust. Can the patient also repeat the instructions and express why those steps are important? This step helps determine if the patient truly understands. Instructions are often forgotten, resulting in the patient returning for the next visit with no progress.
Reviewing and correctly repeating what the patient has said lays the groundwork for the next steps and demonstrates a connection. All of this reassures the patient, who sees that the physician cares.
When you visit medical schools for interviews or second visits, ask students how the doctor-patient relationship is taught. What do they observe physicians doing in the hospital or clinic? Can they tell you about some of the better observations they recall on expressions of patient respect and demonstrations of trust? If they are enthusiastic about this, that’s a plus for the school.
COVID-19’s Impact on Doctor-Patient Relationships
Doctor-patient relationships have always had challenges, but COVID-19 presented a new set of problems that many doctors never anticipated.
Prior to the pandemic, some patients did not want to be seen by a med student or resident. Some didn’t want to see a Black doctor, others didn’t want to see a white doctor, and others did not prefer male, female, LGBTQ, an international medical graduate, a psychiatrist or other mental health professional, and so on.
These patients often express anger about their health situation and direct the anger at health care professionals. As a consultation-liaison psychiatrist, my job is to help the medical team deal with these patients and their families. My main approach is to find something about the patient that I like, or something in common to explore and gain the patient’s trust.
[Read: Show Empathy in Medical School Multiple Mini Interviews.]
Many angry patients have trust issues that relate to prior life experiences. They mistrust the medical profession, the government, their parents, their work supervisors or authority figures in general.
The vast majority of doctors believe the scientific literature and support vaccination for COVID-19. Many have provided care for people who weren’t vaccinated and who adamantly refused to consider the science or the advice of government or physicians.
How do doctors care for sick people in the face of what they see as irrational fear and resistance? By reminding themselves of the Hippocratic oath, looking for something positive in the patient as a human being, treating everyone with respect and giving them the best care.
The lesson is to find some reason to care about the person and show true empathy, then you will have a chance to build on that relationship. Watch for this in the doctors you shadow and ask them how they handled this new hurdle.
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Medical Schools Teach Value of Doctor-Patient Relationships originally appeared on usnews.com
