How to cultivate deeper doctor-patient relationships to create perfect melodies

One of my history professors in college commented to me, “No matter what you choose to do in life, find the passion for what you do, and above all, care.” The word “care” stuck — care is a tough thing to define.

Most people who think of healthcare measure care as outcomes or results. But, care in medicine means so much more.

Care is also the root of the word melody in music. The key to success in fostering the doctor-patient relationship is for it to become a true healthcare partnership, a perfect melody. 

Here are some techniques to boost your practice melodies.

There is a dynamic interplay between doctors and patients that tests psychological processes, social contexts, physical maladies, and above all, individual well-being. The missing part of the partnership often omits one or more of the following: trust, respect, communication, or common understanding.

In my career, I thought about my patients at all times, even during off hours, as many doctors do. We worry. But what I sometimes forgot was that my patients thought about their doctor, too. 

Many patients asked me if I had a good night’s rest or about my mood since they thought it would affect their healthcare outcome. Another way of interpreting these comments was that patients were concerned about whether they could trust their doctor. 

Eventually, after many years in practice, I allowed myself to think along with my patients. I had to surrender to the concept that patients' thinking is no less important than my own, and in some cases perhaps more relevant. Dropping the doctor's superiority facade helped a great deal to help me find that humility. 

A good healthcare partnership is defined as not just about what the outcome is, but whether the best course of action was taken under the circumstances and care was involved. It is about mutual trust and respect between doctors and patients. Despite its importance, trust is a complex subject that has been looked at with different perspectives and theories on how to measure trust has evolved. In Patients' trust in physicians: Many theories, few measures and little data, LH Raeke and SD Pearson found that patient trust subscale correlated most highly with patient assessment of the physician's communication, level of interpersonal treatment and knowledge of the patient.

Patients want to know: “Doctor, is that what you would have done if you or one of your friends or family were in my shoes?” 

There is a difference between communication and relating to patients. I will highlight the art of relating with patients below, but first, let’s discuss communicating.

Communication can be superficial but has to be based on honesty. For many years, I struggled with the best way to obtain the perfect patient history. This process meant communicating, and gathering information, but did not necessarily have to involve relating to patients. 

In fact, many doctors delegate this fact-finding mission to their staff. And, the doctor later uses the information and tries to relate the patient.

As soon as I entered my clinical rotations in medical school, I realized that both physicians and patients need to come to a common understanding about one central problem: both physicians and patients lie. Both don’t always do it intentionally, we just do it.

By wanting to minimize or hide errors, omissions, or untoward outcomes, physicians can have a tendency to stretch the truth or provide cover. Today, the deception may be rooted in financial, legal, or even reputation consequences, but it is also about feelings of inadequacy or shame.

It took me years of clinical experience to realize that patients also dealt with embarrassment and shame. Even when patients are suffering, they want to appear in the best positive light and minimize their plight. When patients offer only simple explanations or omit important details, they are really trying to avoid negative outcomes, judgment, or worse — rejection.

They may also want to gain access to medications, tests, or procedures that they think they need, but don’t. Some of the worst patient visits I had as a physician were trying to reassure a patient that indeed they did not need an antibiotic and their infection was viral in origin. Patients complain if they leave an office empty handed or don’t believe the doctor is right.

In summary, patients want to have access to the best treatment and have the best outcomes by providing only the information they think is important. No one can blame them. 

The only way for physicians and their staff to improve their practice is for good, honest communication.

In this time of readily accessible information on the Internet it becomes essential to emphasize the importance of patient-centered care, making patients feel that you care. The only way to relate to patients is to empathize with them — not merely citing facts or research, and not merely taking down their vital signs.

Everyone in the practice, from the physicians to the front and back office staff, needs to learn how to relate to patients. Interactions with patients have to be professional, yet personal and caring. If the scheduling person doesn’t seem to care if a patient makes a return appointment, then neither will the patient.

Relating to patients and their families means open-ended questions and answers, warm dispositions, encouragement of emotional expression, and demonstrated interest in patient’s lives. That process begins with the first patient appointment in the practice and should never end.  In a clinical trial study titled The impact of patient-centered care on outcomes, finding common ground between doctors and patients was found to be the most important component in predicting positive patient outcomes and now holds place of prominence as central task of patient-centered medicine.

Relating to patients has 3 main components:

Relating to patients is a process. It can be an art form. It can vary depending on location, culture, and many other factors. As it turned out, in my practice, I needed a stern, almost domineering front desk employee from New York to keep my demanding suburban folks in line. Other practices will need to discover and adapt to what fits their needs best.

Physicians face the struggle of being seen as superior. They should never discount patient concerns or fears, even if seemingly insignificant. Rather, they should listen to patients carefully in order to relate to them. This process involves respect, consensus agreement, and often compromise.

Patients constantly anticipate. They guess. At the end of a patient visit, all they may really see is the prescription and ask why couldn’t the physician just call this medication into the pharmacy and save them the trip. 

It is the physician’s job to make sure the patient's visit is worthwhile by relating to the patient about why it was necessary for them to come into the office. The result will be patient empowerment, and them feeling more in control. 

When physicians and their staff relate successfully to their patients, patients feel that the practice is the vehicle necessary for their healthcare journey.

The act of opening up to patients about sharing in their care provides patients authority over their own medical care. Patients compare and contrast their situation with whatever information or experience they can find, looking to diagnose and treat themselves. Physicians need to make the effort to work with patients, sharing their emotions and feelings.

Patients don’t want to have their healthcare issue be rare or unusual. They want their diagnoses to be easy and their treatments to be common and completely effective. They want to have a solution that is reasonable to whatever their healthcare problem is.

Everyone in the office, including the physicians, needs to provide:

Presence is listed last, but it is the most important. Presence means physicians and everyone in the office must be engaged with patients — not thinking or talking about that night’s dinner, the fishing trip over the weekend, or the tennis match on Saturday. Nothing can be more distracting to patients or create greater patient mistrust.

During the early phase of the COVID-19 pandemic, presence had become a challenge, particularly with the increased use of telehealth visits. Without a physical presence, physicians and staff had to ensure patients' emotional presence. 

Telehealth still faces these challenges. In most cases, nothing replaces seeing patients in person, but practices and patients are adapting.

As a physician, you must avoid overestimating your own communication skills and the information you provide. Many physicians speak in complicated terms; patients may not only not understand, they phase out of the conversation.

A physicians’ expressions of emotions can have a significant impact on how comfortable patients will feel. I had patients tell me that they remembered my empathy more than my words after performing long surgeries.

The best practices have the best bedside manner because everyone in the office has presence.

Throughout my career, I have seen a slow evolution away from innate physician bias toward issues such as race, ethnicity, and language. It is not to say these factors no longer exist, but at least we have seen increased awareness among physicians.

My first introduction to physician bias or pre-judgment came when I was an intern working in the emergency room. My fellow intern and I saw a disheveled patient who had fallen down, broken some ribs, and injured his liver. 

While we as surgery interns did all the right things for the patient at the time, we witnessed a well-respected attending physician discharge him too early from the hospital likely because of the patient’s haggard appearance and preconceived notions. The attending thought he was homeless and seeking a night out of the cold.

That attending physician’s lack of emotion and feelings for the patient nearly cost the patient his life. Later that night the patient underwent life-saving surgery in a nearby town. The patient turned out to be a university president who had been on a fishing trip and not bathed in a couple of days. 

Call it a good bedside manner, showing emotion, or just caring for your patients — it is all the same. 

The best practices treat every patient whoever they are or whoever you think they may be as if they were royalty.

“Being” is the essence of why you went into medicine and why patients come to see you as a physician. 

“Being” is defined in your practice as if you and your patient have discovered something tangible and important. That is the definition of a partnership in medicine. You want your practice to be an essential component of that patient's and their families' and friends' lives. You don’t want your patients to go elsewhere, nor do you as a physician or your staff want to ever leave the practice.

Once a patient becomes part of the practice, they become part of its living ecosystem. You and your staff have welcomed them. Your medical practice embodies the complex relationship between physicians, ancillary staff, diagnosis, treatment, and overall patient management.

The health of the medical practice “Being” is a reflection of you and your patients. Your goal is for every patient to want to be part of the community of your practice. 

The description of the “Being” which is your practice is the melody of many successful doctor-patient partnerships.

The doctor-patient partnership reminds us that healthcare is not just about medical expertise but also about the human connection. It is about weaving a harmonious melody of trust, communication, empathy, and care that resonates throughout the patient's healthcare journey, making them feel cherished, empowered, and ultimately part of the practice's living ecosystem.