Connecting with Patients
By Amy Givler, MD | June 29, 2017
by Amy Givler, MD
I had a problem when I graduated from medical school 32 years ago: I looked much too young to be a doctor.
Because of my baby face, I had a hard time convincing patients that I knew enough to properly care for them. But as the months and years passed, though my face didn’t age much, the time it took to develop trust shortened.
Why the improvement? I was exuding more confidence, certainly, as I successfully treated more and more patients. But more importantly I was learning how to really listen to patients and how to make sure they knew I valued them as a person. In other words, although I couldn’t have put it this way at that time, I was learning the mystery of the doctor-patient relationship.
As Sir William Osler said, “Care more particularly for the individual patient than for the special features of the disease.”
I never heard the term, “doctor-patient relationship” until many years after residency, although my third year medical school daughter, Martha Grace, has already had several lectures on the subject. Review articles have been written confirming the virtue of patient-doctor communication. Sometimes just feeling “heard” is enough to move the patient forward on the path toward healing. Sometimes empathy is all that is wanted. Quality communication leads to better health outcomes. The doctor-patient relationship itself is therapeutic.
I’m glad Martha Grace has been better prepared than I was, for she will practice in a more challenging environment. Most people in the 80’s and 90’s were primed to trust their doctor, but this is the world of Google. Now a patient comes to clinic with articles downloaded from the internet, and with a chief complaint that is not “joint pain,” but “I think I have lupus.”
A presentation at a recent pediatric conference described a study of 1,374 parents of young children and their level of trust in doctors. All were presented a vignette of a child with a rash and a three-day fever. Then they were split into three groups: One group had no internet exposure, the second and third were shown screenshots describing the signs and symptoms of either scarlet fever or Kawasaki Disease. All were then told the doctor had diagnosed scarlet fever.
The group who had seen the Kawasaki Disease screenshots were far less likely to trust the diagnosis compared to those who had seen the scarlet fever screenshots. They were also more likely to want a second opinion. Interestingly, those who had seen no screenshots fell in the middle of both trust and desire for a second opinion. Exposure to online information seems to prime patients to expect a particular diagnosis. Now what I want to know – before I walk into an exam room – is, “What has my patient been reading?”
Of course, today we’re not only sharing our exam room with Dr. Google. We also have the ubiquitous cell phones to contend with. When I’ve worked urgent care, many times teens and young adults are glued to their phones when I enter the room – and stay glued until I ask them to put them away. More than half of my patients, young and old alike, will answer their cell phones when they ring – right in the middle of the visit. And even after, I’ve asked them not to answer it. These days, I have to work doubly hard to establish a human connection.
And because of the electronic medical record, we clinicians must – far too often – avert our own eyes to type into the computer. There is power in eye contact. When we look into our patient’s eyes, we are perceived as being more empathetic. I think that is because we are more clearly seeing the human being behind the eyes. When I look into another person’s eyes, empathy stirs within me.
A Noble Profession
My husband Don, also a family physician, recently met an Emergency Medicine resident who had worked as a nurse for years before choosing medicine. She told him, “I can’t tell you the number of doctors I worked with who, when they found out I was going to medical school, told me that if they had it all to do over again, they would never become a doctor.”
Don was so sad as he shared this. “Medicine is such a noble profession. What have we done to make it so distasteful?” I, too, am sad for people who have trained so hard, only to become discouraged and disillusioned. Systems that emphasize technology and which de-emphasize the therapeutic relationship are partly to blame.
Don and I have never regretted becoming physicians, and we are glad that two of our children are in medical school. But apparently we are the exception. During a medical school interview, Martha Grace was asked, “Did your parents discourage you from going into medicine?”
“No,” she said, “they’re not pushing me, but they encouraged me.”
“Surprising,” he said. “Most physician parents try to talk their kids out of it.”
In the past three decades, medicine may have changed radically in many ways, but at its core it hasn’t changed at all. No amount of technological change will remove the need for a personal connection between people who are ill and their caregivers. Martha Grace said it well, “Medicine is moving toward automation more and more. But there will always be patients looking for another human to care about them, and to point them toward healing. I want to be there for my patients.”
As Frederick Buechner said, “The place God calls you to be is the place where your deep gladness and the world’s deep hunger meet.” For many of us, that place is the heart of medicine: the patient-doctor relationship.
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