Fostering the doctor-patient relationship

Many students and residents spend time with me on clinical rotations. It is a privilege to be involved in the education of the next generation. I have not forgotten the mentors who taught me over the years. My only hope is to emulate them now that I am a teacher.

Because there is so much to learn and so little time, often we focus on the science, medical knowledge and management of the patient. Although building a relationship with our patients is as important as knowing the correct study to order or choosing which medication to prescribe, too often it gets less attention.

Last week, I discussed the importance of the “art of medicine” with a student. The same afternoon the most recent issue of the Annals of Internal Medicine arrived. I was pleased to see an article, “Healing Skills for Medical Practice,” written about this very subject.

The authors interviewed 50 practitioners from three states who were regarded by their peers at being particularly skilled at patient relations. They identified eight basic themes, summarized below:

1. Do the little things: Introduce yourself and everybody on the team, greet everyone in the room, shake hands, smile, sit down, make eye contact, give your undivided attention, be human, be personable.

2. Take time and listen: Be still, be quiet, be interested and be present. Often the patient tells me their diagnosis, if only I ask the right questions and listen closely to their answers.

3. Be open: Be vulnerable, be brave, face the pain and look for the unspoken.

4. Find something to like, love: Take the risk, stretch yourself and your world, think of your family.

5. Remove barriers: Practice humility, pay attention to power and its differentials, create bridges, be safe and make welcoming spaces.

6. Let the patient explain: Listen for what and how they understand, listen for fear and for anger, listen for expectations and for hopes.

7. Share authority: Offer guidance, get permission to take the lead, support patients’ efforts to heal themselves, be confident.

8. Be committed and trustworthy: Do not abandon, invest in trust, be faithful and be thankful.

Much of this is basic common sense. Such themes form the essence of any healing relationship. For many of us this comes naturally and without thought, others must work at it just as we do any other clinical skill. If you treat your patients the way you would like to be treated and the way you would like your family to be treated, you will go far in practice. Word of a knowledgeable, thoughtful and caring physician travels fast. You will never be short of patients eager to come see you.

Ann Intern Med. 2008;149:720-724.