Wednesday, November 25, 2015

Successful doctor-patient relationships require honesty

A physician's "bedside manner" is an essential aspect to a patient's treatment. While everyone seeks the best physician, clinically-speaking, patients often forget how important personality is when choosing a doctor.

Successful doctor-patient relationships require honesty


I was at my annual check-up and my physician asked me, “Do you exercise regularly?” I looked down sheepishly and said, “Well, uhh, law school doesn’t give me much free time. So I don’t exercise as much as I probably should. But I bike everywhere in the city, at least two miles a day, five days a week.”

My doctor looked at me through narrowed eyes and scoffed, “There is no excuse for lack of regular exercise. Biking throughout the city does not count. Weight-bearing exercise is especially important for petite women. You need to get yourself to the gym.”

I was so humiliated by this interaction that I left the appointment telling myself that in the future, I will just tell her that I exercise four times a week, both weight-lifting and running, whether or not it’s true. But should I have to lie to feel comfortable talking to my physician?

Maybe my doctor was right. Maybe I should make time to get to the gym more consistently, even if it means getting six hours of sleep instead of seven. But did she have to advise me in such a condescending manner? Probably not.

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A physician’s “bedside manner” is an essential aspect to a patient’s treatment. While everyone seeks the best physician, clinically-speaking, patients often forget how important personality is when choosing a doctor. Especially in circumstances in which the physician will be treating you for an extended period of time, you should be comfortable being open and honest. While a visit to the doctor’s office typically isn’t a walk on the beach, a good doctor-patient relationship can ease the pain.

A successful doctor-patient relationship requires mutual trust and respect. If the patient is uncomfortable with his or her physician’s demeanor, how can the patient be expected to disclose private, and sometimes embarrassing, information? A patient’s refusal to tell the whole story could have grave consequences including a misdiagnosis, missed diagnosis, or improper treatment. While it is ultimately up to the patient to be honest, the physician can create an environment that is conducive to disclosure rather than a setting that encourages lies. The effect of withholding the information is detrimental to both doctors and patients.

Physicians often appear rushed when seeing their patients. Many doctors face financial and logistical pressures to see as many patients as possible in a given day. Physicians are often paid more if they see more patients. And for many physicians, there aren’t enough hours in the day to see their current patients and the many new patients waiting for an appointment. But that doesn't make compassion and candid communication any less important.

Some question whether physicians can “learn” compassion; regardless, it’s not a course taught in medical school in between gross anatomy and biochemistry. A 2009 study found that physicians can be trained to be more humanistic and caring, which surprised many practitioners and academics who believe physicians either “have it or they don’t.” So there is hope, even for those physicians who appear cold and uncaring.

Physicians expect their patients to lie. According to a recent Wall Street Journal article, one physician proclaims, “It's just human nature that patients want to please doctors.” This physician’s explanation appears to be a somewhat egotistical approach. I would argue that it is this exact attitude that causes a patient not to open up to his or her physician.

Maybe patients do want to please their doctors. But it is also likely that patients are intimidated by their doctors and worried that they will be judged and admonished if they do not adhere to the best health practices.

It is essential that doctors step back and realize that while their clinical skills are indispensable, personality matters, too. A caring smile and soft touch on the arm can make a world of difference in a patient’s day.

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Robert I. Field, Ph.D., J.D., M.P.H. Professor, Drexel University Kline School of Law & Dornsife School of Public Health
Jeffrey Brenner, MD Founder of the Camden Coalition of Healthcare Providers, Medical Director of the Urban Health Institute at Cooper University Healthcare
Andy Carter President & CEO, The Hospital & Healthsystem Assoc. of Pa.
Robert B. Doherty Senior Vice President of Governmental Affairs & Public Policy American College of Physicians
David Grande, MD, MPA Assistant Professor of Medicine at the University of Pennsylvania
Tine Hansen-Turton Chief Strategy Officer of Public Health Management Corporation
Drew A. Harris, DPM, MPH Director of Health Policy Program at the Jefferson College of Population Health
Antoinette Kraus Director of the Pennsylvania Health Access Network
Laval Miller-Wilson Executive Director of the Pennsylvania Health Law Project
David B. Nash, MD, MBA Founding Dean of the Jefferson College of Population Health
Mark V. Pauly, Ph.D. Professor of Health Care Management, Business Economics and Public Policy at The Wharton School
Howard J. Peterson, MHA Managing Partner of TRG Healthcare, a national healthcare consulting firm
Paula L. Stillman, MD, MBA Healthcare consultant with special expertise in population health and disease management
Elizabeth A. W. Williams Senior Vice President & Chief Communications Officer for Independence Blue Cross
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