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Closing the Patient-Provider Gap: The Rise of Relationship-centered Care
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I was recently privileged to co-chair, along with Elaine Husni, MD, a summit for fellows in rheumatology focused on hot issues in rheumatoid arthritis, psoriatic arthritis and spondyloarthritis. We hosted 60 fellows from all over the country and — from the evaluations I have seen — put on a successful meeting.
Although much of what was presented was core to these three diseases and likely the subject of the boards, we decided to stretch a bit and included a session on advanced communications. I called it a “Master Class” because it focused on the intangibles in the patient-provider encounter that make a visit successful both in terms of patient and provider, including physicians and advanced practitioners. The intangibles I focused on during my session did not involve measuring the tender and swollen joints or even collecting patient global assessments but rather the quality of the visit that occurs when health care providers and patients truly connect.
While many of us may think this kind of patient-provider relationship is simply intuitive or the result of a “good bedside manner,” more recent analyses suggest this type of quality interaction can be viewed as a skill that can be learned and executed through teaching and modeling advanced communication skills.
Multiple studies have shown that communication skills can be improved with training, and that effective communication improves medical outcomes, safety, patient adherence and even patient satisfaction. In turn, there is also a complementary benefit for the provider. As demonstrated by Boissy and colleagues in findings published in the Journal of General Internal Medicine, when the patient visit explicitly focuses on cultivating a relationship between the patient and provider, there is a corresponding enhancement of provider satisfaction and efficiency and empathy, as well as decreased burnout and improved self-efficacy.
Despite these findings, I was a little reluctant to attempt a modeling of relationship-building to a group of mostly second-year fellows whom I suspected were looking for hard science at this summit. Quite the contrary, the group remained thoroughly engaged, and many commented to me that topics such as “how to build relationships in clinical care” and “how to buffer and build our empathy” are long overdue in rheumatology training.
I have become increasingly comfortable with this area of medical research over the past 15 years in my role as a course director teaching the art and practice of medicine at the Cleveland Clinic Lerner College of Medicine. However, through my work with students, teaching and engaging on the science of empathy and mindfulness, I realize that these are subjects we know very little about in the field of rheumatology.
I recently performed a systematic review of these areas in rheumatology when I was invited to speak at the 2017 American College of Rheumatology annual meeting at a symposium entitled “Empathy, Burnout and Mindfulness.” Not surprisingly, ours was the last session on the last day; yet, despite this time slot, there was enthusiastic support from the attendees and I believe the inclusion of this topic as a major symposium marked a turning point in our field’s readiness to engage in these areas.
I will close by reminding all of us that virtually all the guidelines in rheumatology that focus on treatment, including treat-to-target, start with some wording that says: whatever the treatment or principle, it must be based on a shared decision between patient and rheumatologist. Unfortunately, after this introductory statement there is precious little explanation of what this means and even less on how to achieve it. Relationship-building and empathy are two cornerstones of a successful visit for patients and providers. We need to learn more about the science and we rheumatologists — who I believe are naturally inclined to be good at engaging in such interactions — should be leading the way.
If any of you are working in the relationship-centered care space, please share your thoughts with me by email to calabrl@ccf.org or to me on Twitter @LCalabreseDO.
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- Leonard H. Calabrese, DO, is the Chief Medical Editor, Healio Rheumatology, and Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, and RJ Fasenmyer Chair of Clinical Immunology at the Cleveland Clinic.
Disclosure: Calabrese reports serving as an investigator and a consultant to Horizon Pharmaceuticals.