The physician-patient relationship
It is the patient who carries the burden of illness, but the compassionate physician shares that burden, lifting it when possible and lightening it when that is all that can be done. This sharing of the burden has always been the hallmark of the medical profession.
Richard S. Hollis, MD
Effective physicians combine the ‘science’ of medicine, the knowledge and technology gained over the last 2 centuries, with the art of medicine, which dates back millennia. The earliest healers lacked effective therapy for most diseases but many of their patients improved nonetheless, responding to the therapeutic relationship. The relationship between patient and physician lies at the heart of our work: promoting health, diagnosing and treating disease, and alleviating suffering to the best of our ability.
In effective patient-physician relationship, both individuals feel comfortable, respected, trusting and trustworthy. Effective relationships lead to better rapport, improved adherence, and greater physician and patient satisfaction.
What do patients want from their physicians?
In a 2006 study, 192 Mayo Clinic patients were asked to reflect on the best and worst experiences they had had with doctors and seven themes emerged. Patients identified ideal physician behavior as empathetic, humane, personal, forthright, confident, respectful and thorough. The authors defined each of these in patient terms and described how they could be demonstrated in the clinic. The table below is adapted from reference 2.
| Empathetic | Tries to understand what I am experiencing and communicates that understanding to me | Makes eye contact with patient & family members
Correctly interprets patient’s verbal and nonverbal cues Repeats patient’s concerns Shares personal stories that are relevant Speaks in a sympathetic and calm voice |
| Humane | Is caring, compassionate, and kind. | Uses appropriate physical contact
Is attentive and present Shows willingness to spend adequate time with unhurried movement Helps arrange needed nonmedical assistance (e.g., chaplain or social work) |
| Personal | Is interested in me more than just as a patient and remembers me as an individual. | Asks patients about their lives
Discusses own personal interests Uses appropriate humor Acknowledges patient’s family Remembers details about the patient’s life from previous visits |
| Confident | Assured manner engenders trust – their confidence gives me confidence | Refers to state-of-the-art medical practices
Refers to experience in treating specific medical conditions or performing procedures Open to patient’s queries about medical information from other sources (regardless of accuracy or inaccuracy) Is at ease in the presence of patient, family members, and medical colleagues |
| Forthright | Tells me what I need to know in plain language and in a forthright manner | Doesn’t sugarcoat or withhold information
Doesn’t use medical jargon Explains pros and cons of treatment Asks patient to recap the conversation to ensure understanding |
| Respectful | Takes my input seriously and works with me | Offers explanation or apology if patient is kept waiting
Listens carefully and does not interrupt when the patient is describing the medical concern Provides treatment choices as appropriate but is also willing to recommend a specific course of treatment Solicits patient’s input in treatment options and scheduling Takes care to maintain patient’s modesty during the physical examination |
| Thorough | Is conscientious and persistent | Provides detailed explanations
Gives instructions in writing Follows up in a timely manner Plans to consult other clinicians or literature on a difficult case |
Both patient and clinician bring their own personalities, values, beliefs, stereotypes, expectations and experiences to every clinical encounter. Most patients arrive with some combination of illness, anxiety, past trauma, and pain. Recognizing the importance of the relationship to patient care, how can we show up as the best version of the physician our patients need? We will discuss and reflect on this important question for the rest of FCM.
Communication skills for relationship building
Nonverbal behavior
Research shows that 70% to over 90% of communication is conveyed non-verbally. Attending to this ‘channel’ of communication supports the developing relationship.
- Facial expression
- Eye contact
- Gestures
- Posture
- Space between clinician and patient and position in the room
- Appropriate confidence
- Vocal qualities – rate, rhythm, volume, tone
Establishing rapport
To establish rapport at the start of the encounter, greet your patient and others in the room and introduce yourself and your role in their care. You may also talk briefly about something non-medical, like the weather, travel to the clinic, or a personal interest they’ve told you about before.
Rapport is then built over the rest of the conversation in a variety of different ways, including:
- Inviting your patient to share their perspective and thoughts
- Accepting the legitimacy of your patient’s view and remaining nonjudgmental
- Providing support and communicating your willingness to help
- Dealing sensitively with embarrassing topics
- Creating partnership, by explaining the rationale for questions and exam and sharing your thinking
Demonstrating Empathy
Recognizing the emotion that your patient conveys verbally and responding with empathy is so critical that the next chapter is devoted to this topic.
References & resources
Hollis RS. Caring: A Privilege and our Responsibility. Obstetrics & Gynecology, 83(1) 1994.
Bendapudi NM, Berry LL et al. Patients’ Perspectives on Ideal Physician Behaviors (2006). Mayo Clinic Proceedings, 81(3): 338-344. LINK.
Howe, L. C., Leibowitz, K. A., & Crum, A. J. (2019). When Your Doctor “Gets It” and “Gets You”: The Critical Role of Competence and Warmth in the Patient-Provider Interaction. Frontiers in psychiatry, 10, 475. LINK