It should be obvious that the frontline healthcare team is not an adversary to the patient or their family. Most of us chose this profession to be of service to other human beings. Nurses, pharmacists, therapists, physicians and countless others involved in direct patient care sacrifice years of education and earnings potential to end up in a role where they help patients. Why then does it feel to us sometimes that families and the patients themselves don’t even trust their team? In hushed tones and behind closed doors some of us commiserate and sadly use descriptions like ‘difficult family’ when we are met with suspicion and conflict. Inherently we know that when a family member is ill it is a very stressful time for everyone involved. Patient and their families obviously face a range of emotions, including sadness, anger, fear, and anxiety – and this can lead to communication that is suboptimal. We all know that having a strong patient advocate at the bedside is important, but as healthcare professional we suffer in confrontations where our integrity is questioned. Challenging patient encounters are unsurprisingly correlated with burnout and dissatisfaction. To be fair – patients aren’t the only source of our stress – and at times communication with coworkers can also be fraught with risk.
I recently called the son of a patient to notify him that his parent was stable for discharge and happily relayed his improving labs, stable vitals and no further need for IV medication. I was met with silence for more than a few seconds and then a curt reply that ‘I will have to discuss this with his family physician who has his best interest at heart.’ Ouch. I tried to apologize for any misunderstanding and tried to rephrase my good news. I was met with another ‘I understand, but this doctor has known him for thirty five years and is looking out for him and I need to hear his opinion.’ At this point I was dispirited because I realized the implication was that as an employed hospitalist all I was doing was trying to discharge the patient without much thought and not concerned about his overall wellbeing. I’ve been a hospitalist for more than a decade, so I’ve heard variations of this before : ‘you’re just kicking him out!’ or ‘imagine if this was your mother!’ or ‘doesn’t this hospital care about patients? why can’t you just keep him for another night’ and the list is frankly endless. I try to calmly explain to the families that I discharge patients from the hospital when it is medically appropriate (and not ASAP), and I take my responsibility seriously because hospital readmissions are bad for patients and look bad for us as an institution. I also try to explain that a multidisciplinary team is discussing the patient progress daily including nurses, social workers and case managers.
There’s no pretty way to say this, but repeated interactions like this convince me that there has been a fundamental breakdown in the patient-physician relationship. As a physician conversations like the above make it even more difficult for me to come back day in, day out and practice in a system that treats my colleagues like replaceable machine parts. I suspect there are a number of reasons why patients may not trust doctors anymore. Some of these reasons may include:
- The feeling of being rushed. Some patients feel like they do not have enough time to discuss their concerns with their doctor. The problem is that as more physicians become employed by large healthcare systems; we lose control of our schedule. There is reason primary care physicians are forced to see patients in 15-20 min increments and are always behind. Were it to the physicians themselves they would take their time to perform thorough interviews and exams.
- The feeling of being ignored. Some patients feel like their doctor does not listen to them or take their concerns seriously. Inevitably the EMR and documentation burdens have literally placed a computer screen between patients and their doctors. This leads to distracted visits and patients left wondering whether they are a top priority.
- The rising cost of healthcare. Many patients feel like they are not getting the care they need because they cannot afford it. Many don’t realize that the focus on revenue and profitability is a driving force in the US healthcare system. There are many groups like pharmaceutical companies, device companies, hospitals and insurance companies that set prices. According to many sources, doctors’ salaries account for only about 8% of U.S. healthcare costs.
- The lack of transparency. Some patients feel like they are not being given enough information about their condition or their treatment options.
However, as physicians we can’t just blame ‘others’ in the healthcare system – so physicians must do everything in our power to salvage the sacred patient-physician relationship. It is a crucial aspect of healthcare that can greatly impact the effectiveness of medical treatment and outcomes – if those we take care of don’t trust their team then they are likely to not follow our recommendations. Some ways to improve the patient-doctor relationship:
- Communication: Clear and effective communication is key to building a good patient-doctor relationship. Doctors should take time to listen to their patients, ask questions, and provide information in a way that is easy to understand. Patients, in turn, should be encouraged to ask questions, express their concerns, and provide feedback.
- Empathy: Patients want to feel that their doctors understand their concerns and are invested in their well-being. Doctors who demonstrate empathy and show that they care about their patients are more likely to establish trust and build strong relationships.
- Respect: Doctors should always treat their patients with respect, regardless of their age, gender, culture, or background. Respectful behavior can help patients feel more comfortable and confident in their treatment.
- Shared decision-making: Patients want to be involved in their own care and to have a say in the treatment options available to them. Shared decision-making, where doctors and patients work together to make decisions about treatment, can help patients feel more empowered and invested in their own health.
- Follow-up: Doctors should follow up with their patients after appointments or procedures to check on their progress, answer any questions, and address any concerns. Follow-up communication can help patients feel supported and cared for, even after they leave the doctor’s office.
Varun Verma M.D. is a board-certified internal medicine physician, entrepreneur, patient advocate and author. He is the co-founder of Andwise – a platform designed to empower physicians with the financial knowledge and resources they need to make smart financial decisions.