There is an often quoted physician maxim from a lecture given by Dr. Francis W. Peabody to students at Harvard in 1925: "...For the secret of the care of the patient is in the caring for the patient."
I came across the quote this morning in a blog discussion among physicians about how best to manage difficult patients. The physician went on to say that one of the strategies he uses is to try to understand what might be causing the negative behavior and to address the problem if he can. If that doesn't work, he says he tries to find something to like about the patient. It may take two or three visits, he advises, but it usually helps improve the relationship.
Clearly, this doctor understands that his caring actions, not just his technical skills, can have an important effect on patient behavior, health outcomes and overall satisfaction.
His thoughtful comments got me thinking about the traditional patient-physician relationship and how strangely lopsided it has been in terms of knowledge, power, vulnerability, intimacy and detachment. No wonder we have trouble communicating with each other.
One of the lingering effects of paternalistic medicine—even as the physician-patient relationship evolves to more of a partnership—seems to be how little we as patients think about the physician's day before and after our appointment. If we're honest, many of us don't give him much thought during the appointment either, except in terms of his response to us.
Maybe it's time patients started caring more about their physicians. After all, one of the keys to successful communication is to be able to take the other person's point of view and to understand what he or she is feeling.
Two recent studies provide insights into physicians' concerns about practice-related barriers to developing a sense of connection and mutual understanding with patients.
In "What's Keeping Us So Busy in Primary Care? A Snapshot from One Practice," Richard J. Baron, MD, details the volume and types of services provided by a practice employing five physicians supported by four medical assistants, five front desk staff, a billing manager, a health educator, and two-full-time clerical staff.
Clearly, this doctor understands that his caring actions, not just his technical skills, can have an important effect on patient behavior, health outcomes and overall satisfaction.
His thoughtful comments got me thinking about the traditional patient-physician relationship and how strangely lopsided it has been in terms of knowledge, power, vulnerability, intimacy and detachment. No wonder we have trouble communicating with each other.
One of the lingering effects of paternalistic medicine—even as the physician-patient relationship evolves to more of a partnership—seems to be how little we as patients think about the physician's day before and after our appointment. If we're honest, many of us don't give him much thought during the appointment either, except in terms of his response to us.
Maybe it's time patients started caring more about their physicians. After all, one of the keys to successful communication is to be able to take the other person's point of view and to understand what he or she is feeling.
Two recent studies provide insights into physicians' concerns about practice-related barriers to developing a sense of connection and mutual understanding with patients.
In "What's Keeping Us So Busy in Primary Care? A Snapshot from One Practice," Richard J. Baron, MD, details the volume and types of services provided by a practice employing five physicians supported by four medical assistants, five front desk staff, a billing manager, a health educator, and two-full-time clerical staff.
Dr. Baron describes the daily challenge of preserving long-term trusted relationships with patients while also attending to:
- Administrative forms
- Correspondence from health plans
- Reports on home care and physical therapy
- Telephone calls
- E-mails
- Prescription refills
- Laboratory reports
- Imaging reports
- Consultation reports
Efforts have been underway for the past few years to redesign the practice of primary care. In the meantime, medical school graduates are choosing other specialties which doesn't bode well for the future of family medicine.
Electronic Medical Records Both Help and Hinder Communication
Another study based on in-depth interviews with clinicians in twenty-six physician practices found that, in general, EMRs made accessing and sharing information easier, facilitated education during visits and allowed for more "quality" time with patients.
Some physicians expressed concern that using a computer during a visit distracted them from the patient. Others worried that the vast amount of available information might lead physicians to ask fewer open-ended questions—e.g., about the effect of an illness on the patient's life—or to listen less.
The takeaway message from these studies and a growing body of medical literature on the topic is encouraging—physicians want to spend more quality time with patients and are looking for ways to foster better communication.
What You Can Do
If you are dissatisfied with the length or quality of time your doctor spends with you, it might help to consider all the competing demands for his time...and plan accordingly.
The best way to get the time you need is to respect the doctor's time and that means preparing for the visit like you would for any professional meeting:
Electronic Medical Records Both Help and Hinder Communication
Another study based on in-depth interviews with clinicians in twenty-six physician practices found that, in general, EMRs made accessing and sharing information easier, facilitated education during visits and allowed for more "quality" time with patients.
Some physicians expressed concern that using a computer during a visit distracted them from the patient. Others worried that the vast amount of available information might lead physicians to ask fewer open-ended questions—e.g., about the effect of an illness on the patient's life—or to listen less.
The takeaway message from these studies and a growing body of medical literature on the topic is encouraging—physicians want to spend more quality time with patients and are looking for ways to foster better communication.
What You Can Do
If you are dissatisfied with the length or quality of time your doctor spends with you, it might help to consider all the competing demands for his time...and plan accordingly.
The best way to get the time you need is to respect the doctor's time and that means preparing for the visit like you would for any professional meeting:
- Decide what is most important for you to discuss, make a list and show it to your doctor at the start of the appointment
- Have a current list of prescription and over-the-counter medications and dosages handy
- If test results will be discussed, followup to make sure they have been received by your doctor before your visit
- Share information that may be useful for the doctor to know
- Express your feelings and beliefs about your illness
- Be informed and actively participate in decisions about your care
- Make sure you understand what's wrong, what you need to do and why...repeat the information back to the doctor before you leave the office
- If there is something you don't understand, ask the doctor to explain it again
- Bring a close relative or trusted friend for moral support and/or to take notes
- If you feel you need more time, schedule another appointment
References
Baron RJ. What's Keeping Us So Busy in Primary Care? A Snapshot from One Practice. New England Journal of Medicine V362:1632-1636, April 29, 2010. Accessed at http://content.nejm.org/cgi/content/full/362/17/1632
O'Malley AS, Cohen GR, Grossman JM. Electronic Medical Records and Communication with Patients and Other Clinicians: Are We Talking Less? Center for Studying Health System Change No. 131, April 2010. Accessed at http://hschange.com/CONTENT/1125
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