Connecting with Patients
I can never forget the dermatology clinic, where I was rotating in, as a post graduate trainee. “Use this medicine once, see me back in a week”, said the doctor handing over the prescription to the middle aged woman who looked startled and confused even at the end of consultation taken for rash and itching all over the body.
Exactly a week after this short consultation, the poor patient returned with the same complains and told the doctor that the treatment did not work at all and she could not even sleep now with severe itching. The doctor looking a bit goaded asked, “Did you apply the lotion properly all over the body for 24 hours?” and the petrified woman answered, “I thought you said to take the medicine by mouth, so I drank it all in one go.”
Bitter experiences like this one makes one wonder if doctors are less knowledgeable or is there something else, may be an X-factor missing in the consultation, which is even more important for a patient than the doctor’s knowledge or procedural skills. Another example, which my supervisor gave, was about his gardener who had some scars on his face. On asking he revealed that it was caused by a severe reaction to a medicine prescribed by his General physician (GP), but he further added, “But it wasn’t the doctor’s fault, he is an excellent doctor”. When my supervisor asked him what makes him think so, he replied, “Oh! I feel so good when I talk to him; he’s very friendly and down to earth…”
Doctors are judged initially by lay persons with the number of degrees written after their names, so what if it’s even a R.M.P, which means nothing more than a “Registered Medical Practitioner”. This holds true only till the first visit to the doctor after which the patient exactly knows whether he wants to come back to the same doctor or not. Although it sounds just right from the patient’s perspective to change the doctor if the doctor does not appeal to him and obviously if the patient can afford it but from the doctor’s viewpoint this is “doctor shopping” which usually annoys the physician. So what is it that makes a doctor excel and get an edge over other practicing doctors in the same field?
A doctor who not only is a master of his field but he is also someone who shares a good rapport with most patients. What makes the patients come back to the same doctor sometimes saying that the patient did not feel the need to take the medicines prescribed because he/she already felt much better just after talking to the doctor? “The Placebo effect”.
These are a few questions which need to be pondered in order to understand the art of consultation, the outcome of which is physician and patient satisfaction at the end of the consultation. Research has shown that the traditional authoritative approach to the patients, which is based on the disease rather than the individual with the disease, does not reduce morbidity from diseases as much as a patient-centered care does in which the doctor’s role is of a counsellar or facilitator. This consultation style not only to develops “more expert” patients, where the doctor shares the management plan with the patient, but the patient is more likely to disclose his real reason for consultation, his ideas, concerns and expectations with having a particular complain.
When the patient contributes to the decision making in his management he is more likely to be compliant with treatment and return for a follow up with the doctor and this is how a doctor is able to build a long-lasting rapport with the patient. It’s also important to listen tolerantly to the patient and remain non-judgemental throughout the consultation. I still remember my professor saying “Listen to the patient, he is telling you the diagnosis”. House keeping is yet another important part of consultation when the doctor himself has to control his own opinions and emotions in favour of the patient. According to the World Health Organization, ‘Patients and physicians have begun to realize the value of elements such as faith, hope and compassion in the healing process”.
In a 10 minutes patient-doctor consultation, how are these fundamental concepts instilled? In my opinion, when the doctor can actually connect with the patient and is able to build a rapport these elements as a reflex are incorporated and when the patient can feel this happening, we are actually becoming better doctors.
About the Author: Dr Faridah Amin is a PhD scholar and Family Physician working at Aga Khan University, Karachi, Pakistan as a a part time lecturer. She can be reached at: [email protected]
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