Patient-Physician Relationship

Physician Survival Skills - 10 basic steps:

At Work:

Take responsibility only for things you can control
Learn to recognize the signs of burn-out
If feeling stressed, take a Ten Second Break prn
Ask for support when you need it
Set realistic career goals

Away from Work:

Protect time for Family, Friends, & Fun
Pursue interests outside medicine
Exercise
Spend some time alone
Take annual vacation

10 Basic Steps for Successful Patient Interviews
according to Dr. Hector Anguiano, Chief of OB/GYN, San Gabriel Valley Service Area

PREVIEW chart, whenever possible
KNOCK before entering exam room
GREET patient by name & INTRODUCE yourself
POSITION YOURSELF to patient's eye level
Maintain direct EYE CONTACT, as appropriate
ALLOW PATIENT TO SPEAK interrupted (1-3 min)
ACKNOWLEDGE patient's CONCERNS & validate FEELINGS
Monitor patient's BODY LANGUAGE
EXPLAIN diagnosis, treatment, & follow-up
Obtain CLOSURE & give patient your CARD

Resolving Disagreements in Patient-Physician Relationship (JAMA Oct.20,1999;282:1477-1483)

3 C's of Ideal Physicians

Confidence - Competence
Caring
Communication

REF: Mayo Clinic Procedings March 2006

Seven Behaviors, Definitions, and Supporting Quotes of Ideal Physicians

Ideal physician behaviors Definitions Representative quotations*

Confident
The doctor’s assured manner engenders trust.
The doctor’s confidence gives me confidence.
“You could tell from his attitude that he was very strong, very positive, very confident that he could help me.
His confidence made me feel relaxed.”

Refers to state-of-the-art medical practices
Refers to experience in treating specific medical conditions or performing procedures
Is not disturbed by patient’s queries about medical information acquired from other sources (regardless of accuracy or inaccuracy)
Is at ease in the presence of patient, family members, and medical colleagues
Empathetic
The doctor tries to understand what I am feeling and experiencing, physically and emotionally, and communicates that understanding to me.
“One doctor was so thoughtful and kind to my husband during his final days.
He also waited to tell me personally when he found a polyp in me, because my husband died from small bowel cancer and he knew I would be scared.”
Makes eye contact with the patient as well as family members
Correctly interprets patient’s verbal and nonverbal concerns
Repeats patient’s concerns
Shares personal stories that are relevant
Speaks in a sympathetic and calm tone of voice
Humane
The doctor is caring, compassionate, and kind.
“My rheumatologist will sit and explain everything, medication, procedures.
I never feel rushed. He is very caring. If I call, he always makes sure they schedule me.
He told me he knows when I call, it is important. I appreciate his trust.”
Uses appropriate physical contact
Is attentive, present to the patient and the situation
Indicates willingness to spend adequate time with patient through unhurried movements
Helps arrange needed nonmedical assistance for the patient (eg, chaplain or social work services)
Personal
The doctor is interested in me more than just as a patient, interacts with me, and remembers me as an individual.
“He tries to find out not only about patients’ health but about their activities and home life as well.”
Asks patients about their lives
Discusses own personal interests
Uses appropriate humor
Acknowledges patient’s family
Remembers details about the patient’s life from previous visits
Forthright
The doctor tells me what I need to know in plain language and in a forthright manner.
“They tell it like it is in plain English.
They don’t give you any Mickey Mouse answers and they don’t beat around the bush.”
Doesn’t sugarcoat or withhold information
Doesn’t use medical jargon
Explains pros and cons of treatment
Asks patient to recap the conversation to ensure understanding
Respectful
The doctor takes my input seriously and works with me.
“She checks on me. She also lets me participate in my care.She asks me when I want tests, what works best for my schedule. She listens to me. She is a wonderful doctor.”
Offers explanation or apology if patient is kept waiting
Listens carefully and does not interrupt when the patient is describing the medical concern
Provides choices to the patient as appropriate but is also willing to recommend a specific course of treatment
Solicits patient’s input in treatment options and scheduling
Takes care to maintain patient’s modesty during the physical examination
Thorough
The doctor is conscientious and persistent.
“My cardiac surgeon explained everything well. The explanation was very thorough. He was very concerned about my recovery after the surgery. I thought it was special how well he looked after me following the surgery. Not all surgeons do that. They are not interested in you after you are done with surgery.”
Provides detailed explanations
Gives instructions in writing
Follows up in a timely manner
Expresses to patient desire to consult other clinicians or research literature on a difficult case

*The quotations in this table are excerpts of longer quotations in the transcripts. Respondents commonly mentioned multiple attributes in describing their best physician experience. For example, the quotation used to illustrate “humane” also incorporates “respectful” and “thorough” and was coded accordingly.

*Specific clues will affect patients differently. Although many patients are likely to appreciate a physician’s empathy in sharing a relevant personal story, this can be a neutral or even a negative experience for some patients. There is no substitute for physicians knowing their patients and responding accordingly. The illustrative humanic clues presented in this table are consistent with the research reported in this article.

2006