Shifting the Time Paradigm, a Simplistic Approach to Fostering the Physician-Patient Relationship
By Alicia Fields
Alicia Fields is a first-year medical student at the University of Kentucky College of Medicine. Prior to medical school, she practiced as a nurse practitioner and earned a Doctor of Nursing Practice from Frontier Nursing University in Hyden, Kentucky. She remains passionate about building meaningful relationships with patients and serving as a mentor to students pursuing health careers.
Time. There never seems to be enough of it. As a medical student, I feel the pressure each day to manage the tasks at hand with the time I have. In medicine, we know the situations when minutes matter most. Even in non-emergent scenarios, we feel the stress of managing our time wisely to promote the best clinical outcomes in an ever-evolving field that consistently increases in complexity. Whether we want it to be or not, health care has become a business. There are productivity expectations, patient satisfactions scores, hours of clerical work with electronic medical records, and a multitude of administrative tasks that can leave physicians feeling as though they have lost their reason for becoming a physician in the first place. It is my opinion that the current practice of medicine makes it more difficult to foster the physician-patient relationship, but recognizing the challenges in health care is the first step to addressing them in a positive, impactful way that can improve satisfaction for both the clinician and patient.
So how does one overcome these challenges to foster the physician-patient relationship and deliver compassionate care? Ask anyone in medicine and you will undoubtably receive a variety of responses with theories and suggestions about external factors that overcomplicate the delivery of care. When asking myself this question as I prepared to write my response to the prompt, there is one method that I feel is relatively simple to implement in day-to-day interactions with patients. This approach goes all the way back to the basics and our introductory medicine courses as first-year students – utilization of strong communication and interpersonal skills. Knowing that individual time with patients has declined over the years due to the other requirements physicians have, we must be skilled in gathering the necessary information to develop appropriate treatment plans while also making a meaningful impact on the lives of our patients that entrust us with their care. There are multiple opportunities during each patient interaction where we can foster the relationship and support the emotions of the patient. This begins from the time we knock for permission to enter the patient’s room until the time we clarify there are no further questions and rise to exit. Making eye contact as we introduce ourselves and confirm the patient’s name is a powerful way to show respect. Asking how the patient prefers to be addressed is an impactful way to introduce open ended questions. Inviting patients to share their ideas and feelings regarding the chief concern can be extremely helpful in understanding their goals and expectations of the visit. It can also aid in applying one of my favorite approaches to patient care which is the Platinum Rule. The Platinum Rule is to treat others the way they want to be treated. For this to be possible, the physician has to truly know who they are caring for and this comes from establishing genuine relationships.
I would be remiss if I did not discuss the concept of empathy and the role it plays in fostering trust within the physician-patient relationship. The ability to empathize with patients is an essential skill that helps physicians deliver more compassionate care while also making patients feel more comfortable. A physician’s ability to express empathy can lead to increases in patient satisfaction and improved health outcomes. Physicians who lack empathy may be perceived as uncaring making the patient less likely to share pertinent information. Showing patients that you understand their feelings makes one seem more human and makes patients more likely to divulge the necessary information to make a diagnosis. I am not implying that every visit should be lengthy. In fact, connecting with patients and establishing a rapport has the potential to shorten subsequent visits. My belief is that the ability to recognize the patients that might need an extra five minutes of your time is critical for the human side of medicine. For the patient who mentions their children or grandchildren, take a moment to show genuine interest in their loved ones. For the patient who is frightened about their diagnosis, let them know you are with them every step of the way. For the patient who shares difficult details with you that they may have never discussed with anyone else, thank them for trusting you with this information.
The reality is that the business and financial aspects of medicine that some may view as less fulfilling will never go away. The time available in each day will also remain a finite 24 hours. Clear, effective communication with patients and recognizing those scenarios that require extra time exemplifies the desire that led many physicians to medicine – the dedication to caring. I believe physicians who can utilize these communication skills have higher satisfaction in their careers from the joy they feel as they make a positive impact on the lives of the patients they serve. I look forward to interacting with patients more as I progress through my medical school curriculum. For now, I will hone my skills as I interact with standardized patients and smile as I say “tell me more”.