If you’re wondering why so many patient office visits turn into a tug of war, it’s partly because physicians and patients are often on different ends of the rope.

To the physician, illness is a disease process that can be measured and understood through laboratory tests and clinical observations. The physician’s focus is more on keeping up with the rapid advances in medical science than on trying to understand the patient’s feelings and concerns. To the patient, illness is a disrupted life and patient satisfaction comes primarily from a sense of being heard and understood. To make communicating in a timely manner more complicated there’s the “difficult” patient, one with too many problems for one visit, one who does not follow instructions, others who are demanding or controlling etc.

Physicians who can’t help bridge communication gaps with patients are more likely to end up in court. An analysis of 45 malpractice cases (1) found that many of the physicians being sued delivered information poorly and devalued the patient’s views.

Despite the fact that physicians and patients will often be on opposite ends of the healthcare system, physicians who practice the following six strategies will help the physician-patient relationship deepen into a healing partnership.

1. Cultivate a patient-centered partnership. The patient desires to be known as a human being, not merely to be recognized as the outer wrappings for a disease. In a video-taped study of 171 office visits, physicians who encouraged patients to talk about psychosocial issues such as family and job had more satisfied patients and the visits were only an average of two minutes longer. Incidentally, physicians also benefit from the patient-centered approach, researchers note, because they feel more job satisfaction and are less likely to burn out.
   
   
2. While with the patient, check your posture and body language. A fascinating study of time perception found that when physicians sat down during an office visit, the patients always thought the visit was longer than when the physicians remained standing, even though the length of both visits was exactly the same. Other simple gestures, such as leaning forward, have been found to help the patients relax, as well as improve satisfaction and recall.
   
   
3. Ask about his/her concerns and opinions with open-ended questions , such as “What’s been going on since you were here last?” In the JAMA study, last minute questions - a pet peeve for many physicians - occurred less frequently when the patient was invited to talk.
   
   
4. To improve your patient’s willingness to follow your recommendations, build mutual trust. Research confirms that the health of the physician-patient relationship is the best predictor of whether the patient will follow the physician’s instructions and advice.
   
   
5. Develop a system to communicate all test results to patients. No news is good news, patients often assume, but according to a survey published in Archives of Internal Medicine, one in three physicians do not always inform patients of abnormal test results, especially if the results are mildly abnormal. About half the physicians surveyed thought it was important to inform patients of normal results, but only 28% always did so.
   
   
6. Respect patients as experts in the experience of their illness . Accept the patient’s unique knowledge as just as important to the outcome as the physician’s scientific knowledge.

Aside from the typical challenges associated with bridging communication gaps with patients, some physicians experience this “tug of war” on a broader scale. A new theme in healthcare risk management is the physician whose persistent, problematic behavior can affect medical care delivery, anger patients or co-workers and possibly trigger a lawsuit. The current terminology for this individual is “disruptive physician.”

Strong Medicine: The Challenge of the Disruptive Physician is the title of a presentation given by L. Casey Chosewood, MD, at a recent medical meeting. Dr. Chosewood, who lectures to state and national audiences frequently on this topic, suggested that the challenge of practicing medicine in our managed care, payor-driven environment is one stressor that may contribute to physicians’ disruptive behavior.

What is disruptive physician behavior? It’s not just “difficult” or “different,” notes Paul Earley, M.D., Medical Director of Atlanta’s Ridgeview Institute. Disruptive behavior is actually dangerous, reducing the healthcare staff’s ability to render optimum care, and at times has a negative impact on patient care. Recognizing and addressing disruptive behavior of any member of the healthcare staff is a critical first step. Specific treatment programs for disruptive physicians have been developed.

Coming up in the next MAGNET, The Physician-Patient “Tug of War” Part Two
(How physicians can help patients learn to bridge communication gaps.)

For more information, call Cleveland Williams at 1-800-294-5384 or visit such websites as www.EarleyAssociates.com and review the following references:

A Practical Guide to Preventing and Solving Disruptive Physician Behavior , by Richard A. Sheff, MD and Todd Sagin, MD, JD (2004).

Marvel KM et al Soliciting the Patient’s Agenda: Have we improved? JAMA 1999; 281; 283-287.

Suchman, AL et al A Model of Empathic Communication in the Medical Interview, JAMA 1997, 277; 678-682.

Footnotes

1. Beckman HB et al. The doctor-patient relationship and malpractice: Lessons from plaintiff depositions. Arch Intern Med 1994 Jun 27; 154(12):1365-70

(Part 2)