Seems like a silly question, right?
No one ever asks if you get along with the cashier at the grocery store or the barista at your neighborhood coffee shop. For most folks choosing a doctor means finding someone in your area who’s taking new patients with your insurance, which usually isn’t too many.
Simply getting an appointment is hard enough, so expecting a pleasant experience and a good relationship with the doctor seems to be an unreasonable request, like asking for a unicorn who also speaks fluent Spanish. Many people don’t think patient-physician relationship is particularly important; they’re looking to the doctor for medical advice, not to be a friend. In these days of electronic medical records and 15 minute appointments, many physicians simply don’t have the time to get to know patients and find out their motivations, goals and fears. It’s even harder for patients with language and cultural barriers; for example, physicians talk more and listen less to black patients than to white patients.
So why do we care?
Decades of research have actually shown that a good relationship with your physician is important to your health. Patients who have good relationships and effective communication with their physicians are more satisfied with their care, better able to manage their medical problems, and more likely to share information about their condition that leads to accurate diagnosis. Better relationships lead to patients that are more likely to take their medications and follow physicians’ advice. Various studies have even found that productive patient-physician communication is associated with lower blood pressure in patients with hypertension, less patient anxiety in patients with generalized anxiety disorder, and less organ damage among patients with systemic lupus erythematosus. There’s also evidence that patient-centered communication can lead to reduced spending on tests (but longer appointments). Effective communication leads to more satisfied physicians, too – and fewer malpractice claims by patients.
Many factors contribute to the patient-physician relationship, including patients’ trust in physicians, active patient participation, patient involvement in decision-making, and providing adequate time for patients to ask questions. Physician communication skills are paramount, especially empathy, clear explanations, active listening, and respect for the patient. An expert panel concluded that physicians should include the following seven elements in all patient visits:
- Build the doctor-patient relationship
- Open the discussion
- Gather information
- Understand the patient’s perspective
- Share information
- Reach agreement on problems and plans
- Provide closure
Factors related to the health care system can also impact the patient physician relationship, including continuity of care (seeing the same physician multiple times), patient choice in their selection of physicians, accessibility of physicians, and providing sufficient encounter time. Encouragingly, formal training programs for practicing physicians have been shown to improve the quality of communication with patients, and a study of a training program for oncologists demonstrated an increase in the emotional well-being of cancer patients and their quality of life
We know that effective communication and patient-physician relationships lead to better health outcomes, and we have a pretty good idea of what elements are necessary for those relationships.
Unfortunately most medical care in the US doesn’t measure up. Most primary care visits do not include the seven elements mentioned previously. Physicians interrupt their patients within 30 seconds, on average, after they begin to state the reason for their visits and most patients do not complete their statements after being interrupted. Doctors tend to overestimate their communication skills; for example, the American Academy of Orthopedic Surgeons surveyed more than 1500 patients and physicians about communication. 75% of the orthopedic surgeons believed that they communicated satisfactorily with their patients, but only 21% of the patients reported satisfactory communication with their physicians.
If we know that effective patient-physician communication is important and benefits patients, why doesn’t it happen?
For one, physicians have limited formal communications training in medical school and much of what we learn comes from observing older physicians, who aren’t always the best role models. After medical school most physicians receive no training or feedback about the way they communicate with patients. In our current health care system, health organizations and physicians are financially rewarded for seeing as many patients as quickly as possible, which is not conducive to appointments of the appropriate length. Patients often can’t get in to see their physician when needed, so they head to urgent care or the ER where they meet a new doctor who doesn’t know the patient or their medical history. Health insurance plans change often, so the physician you see this year may not be the one you can see next year, leading to poor continuity of care.
So what can you do to improve communication with your physician?
- Prepare, be organized, and prioritize: You may only have a few minutes with your doctor, so bring a list of your concerns and discuss them in order of importance. If you don’t have time to get to everything, ask to book another appointment in a week or two.
- Tell the truth: Most patients tell physicians what they want to hear. (“Yep, I take that cholesterol pill every day doc”). This may make the appointment go smoother, but not being honest – about the side effects you’re having from your medications, about your concerns over the costs of the tests your physician just ordered, or how you actually got that nasty rash – can lead to inaccurate diagnoses and poor care. Remember, the doctor is there for your benefit so give them the full story and the best shot to provide excellent care.
- Ask questions: If your physician recommends a treatment or test that you don’t understand, ask them as many questions as it takes until you have enough information to make an informed decision. Many people feel uncomfortable challenging physicians, but it’s the patient-physician team that determines the quality of care that’s provided. If you and your teammate aren’t on the same page then care will suffer.
- If you’re unsatisfied with your physician’s communication, tell them. Waiting for the doctor to bring it up won’t work, probably because the physician thinks they’re doing a great job communicating. Try to be as specific as possible with your concerns and how the physician can address them. If that doesn’t work, ask to speak to the clinic manager or the patient experience supervisor.
- Don’t be afraid to break up with your doctor: Not all relationships can be saved – sometimes you just have to move on. There’s plenty of doctor-fish in the sea.
Many resources are available for patients on this topic, including this useful guide from Consumer Reports.
Nathan Moore is a physician in private practice.