The Doctor-Patient Relationship

By Dr. Miesha Merati

“Availability, affability, and ability, in order of importance.”

I remember the dermatologist who mentioned this to me as the cardinal rule of a successful practice. However, my experiences as an early career dermatologist taught me that the way you make patients feel is an essential underlying motif that determines a successful doctor-patient relationship.

How many of us have faced a disgruntled patient after a tumultuous work day, filled with complicated cases and pure chaos? Now, how many of us are able to elate the patient when it seems like all odds are against us? Truly the latter is a skill that cannot be learned in a textbook and remains an attribute to what makes a physician simply outstanding in the patient’s eye.

Patient satisfaction is essential for treatment outcomes, patient retention, physician reputation, medical malpractice, and nowadays, is even linked to reimbursement. A rushed doctor with shorter visits, less explanation, and fewer partnership conversations (i.e. asking for the patients opinion) contribute to a negative perception of overall care and sometimes treatment outcomes.

“Patients who like their doctors don’t sue, no matter what their lawyer says.”

An amicable physician-patient relationship may be the best antidote to getting sued. By making a patient feel as though their claims are dismissed, ignored, or not fully considered, doctors render their reputation liable to medical malpractice lawsuits, even if there is no basis to the case. A study that reviewed litigated obstetricians suggested that a failure to achieve a favorable physician-patient relationship was more likely to lead to malpractice suits than mistakes in clinical care. In fact, doctors in the lowest third of satisfaction ratings had a 110% higher chance of facing lawsuits. ^1,2

In an ever increasing push to see a high volume of patients, it is sometimes difficult to give each patient the time he or she deserves; however, recent CPT changes that account for time spent with the patient may potentially improve this stressor. Effective communication with patients takes time, so consider allotting an extra few minutes to discuss, as it may save much headache in the future.

Here are some additional tips to improve the patient-physician relationship:

• Practice with empathy. Use terminology like “I understand how you feel.”
• Avoid downplaying the patient’s concerns. If a patient presents with chief complaints that are overwhelming for the time alloted for the visit, see if he or she is amenable to returning for another visit, when you can not only follow-up on the current dermatologic problem, but also address the additional complaints in more detail. Most of the time, the patient is more than willing to return. 
• Actively involve the patient in the decision-making process. Use terms such as “we” or “decide together” to show that you’re partnering with the patient. 
• Be aware of your body language. Avoid staring at a computer screen or iPad. Sitting with the patient gives the perception of more time spent. 
• Check for patient comprehension by asking patients to “teach-back” to the provider and address the patient on their level. Avoid using complex medical terminology which may confuse or insult the patient. 
• Acknowledge issues; if you’re late for a patient visit, instead of ignoring the issue, take responsibility and express your desire to improve flow within the clinic.³
  

In an age where there is an abundance of non-dermatologists claiming to be “skin-care experts”, it is important for the dermatologist to stand out not only in knowledge and efficacy of treatments, but also in the interaction with the patient. Providing the highest quality of care will reduce liability, improve patient outcomes, encourage patient retention, and improve physician overall well-being.



References

¹ Schleiter, Kristen E. Difficult Patient-Physician Relationships and the Risk of Medical Malpractice Litigation. AMA Journal of Ethics. 2009; 11(3): 242-246.

² Roter, Debra. The Patient-Physician Relationship and its Implications for Malpractice Litigation. Journal of Health Care Law and Policy. 2006; 9(2): 304-314. 

³ Margosian, Emily. What You Say Vs. What Patients Hear. Dermatology World. 2018.

 

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