Five ways to enhance the doctor-patient relationship

Effective communication is the key to optimizing the doctor-patient relationship. Curing disease includes much more than identifying the issue and prescribing the necessary treatment.

Oftentimes, patient dissatisfaction stems from a breakdown in communication with their physician. Sir William Osler famously stated: "The good physician treats the disease; the great physician treats the patient who has the disease.”

Here are five ways to help ensure a successful doctor-patient relationship.

1. Get to know patients as individuals

The best time to get to know the patient is on the initial visit. Schedule first meetings at the beginning or end of the day, so that you aren’t rushed. Open-ended questions that reveal character traits, coping skills, support networks and the importance of religious faith in patients’ lives can be fruitful in managing information delivery and helping the patient and family transition through physical and emotional stresses.

Asking important questions can show patients that you’re interested in them as individuals and the answers can provide valuable insight. These questions include:

  • “How would you describe yourself as a person?”
  • ”Are you the type of person who worries or gets anxious?”

2. Leave the computer out of the visit

The electronic medical record may be an important record-keeping advancement, however, data show that it has had a deleterious impact on the doctor-patient encounter. Every moment spent gazing at the computer decreases eye contact with the patient and reduces a patient’s willingness to share psychosocial concerns. Review information before the visit. If you absolutely need to use the computer, let the patient know beforehand. Then dictate/type afterward.

3. Be empathic

Empathy is the key to establishing and maintaining a close physician-patient relationship. The core aspects of empathy are reflection, exploration and validation. Listen and observe attentively to what the patient is expressing verbally and non-verbally. Reflect/comment on emotions and concerns that encourage the patient to:

  • Share: “You seem sad today.”
  • Explore: “Tell me more about why you are feeling the way you do.” Then
  • Validate/normalize what the patient is feeling: “Anyone might feel distressed under these circumstances.” 
  • Try to avoid phrases like: “I understand how you feel.” Although well-meaning, patients might find that hollow (thinking “he/she really can’t understand”).

4. Know how to give difficult news

All physicians need to give difficult news to patients at one time or another. The SPIKES protocol of Baile et al (The Oncologist, 2000) is highly recommended as a guide to delivering bad news. The core elements include:

  • Giving information when supportive people are present
  • Assessing the perception of the patient regarding their situation
  • Asking the patient permission to give information
  • Giving information calibrated to the situation
  • Summarizing the information given, and
  • Having a strategy going forward

Patients vividly recall how doctors gave them difficult news, whether done well or done poorly.

5. Survey for all concerns

The concern the patient presents may not be the main reason they are seeing you. Emotional issues may mask as somatic complaints. Thus, a patient presenting with fatigue may actually be depressed. There also may be multiple concerns, both somatic and psychosocial.

Be aware of the “doorknob question” where patients bring up their most important concern as you are leaving the exam room. Having discussed and addressed the main reason for the visit, a good question to ask at the end of every visit is “have I addressed all your questions and concerns?”

Mark Hoffman, MD, is a medical oncologist at the Monter Cancer Center and associate professor of medicine at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. He has written and taught extensively on the topic of doctor-patient communication.