How doctors can improve patient interactions

by Lockup Doc

Physicians learn a lot about many different topics, both in medical training and in practice. However, there are some life lessons that we never learn as well as when we become patients ourselves.

When I was 13 or 14 years old, I regularly interacted with 2 different physicians with disparate interpersonal styles. Little did I know then that these seemingly meaningless encounters would indelibly shape my own beliefs about how people should treat each other. Ironically, many years later the experiences would help guide me as a physician in my interactions with my own patients.

For a couple of years I was the regular patient of a dermatology clinic. Two dermatologists ran the practice together, and in order for me to get an appointment that worked with my family’s schedule, occasionally I would need to alternate seeing each of them. I’ll refer to one of them as “Dr. A” and the other as “Dr. F.”

I was somewhat shy as an adolescent, and sitting in an exam room wearing only a gown and underwear always made me a little anxious.

However, any unease I may have experienced evaporated when Dr. A entered the room. He politely knocked, awaited my response, and entered the room with a smile on his face. “Hi ___, how are you today?” he’d say as he put out his hand to shake mine. He didn’t spend an excessive amount of time with me, but he did put effort into making small talk. He never examined me without first talking with me for a couple of minutes. He asked me about the medication I was taking and how it was working. He asked me if I had any questions.

Even though I was only a kid, he treated me as if I were an adult. He seemed genuinely interested in me as a person. I felt respected.

I mattered. He cared.

My experience with Dr. F was quite the opposite. Sitting in the cold examining room feeling vulnerable and dreading the encounter, I’d hear a quick knock on the door, and without delay, it opened. Dr. F would waltz into the room with a face devoid of expression. He’d robotically mumble an incomprehensible monosyllabic greeting resembling caveman-speak. He never extended his hand to shake mine. Other than briefly asking me about my progress, he barely spoke. Within 30 seconds of entering the room he examined me. He then wrote out more prescriptions and made his exit.

I would leave my appointments with him feeling disappointed and disrespected.

He didn’t care. I didn’t matter.

Now, I do realize that physicians are fallible human beings. We all make mistakes, and we all have our bad days. I’ve noticed that for myself, I’m most likely to have difficulty emulating Dr. A when I am overwhelmingly busy, behind schedule, and stressed. When a person is sleep-deprived and doesn’t have time to go to the bathroom or eat, he or she tends to get into survival mode, and exhibiting a compassionate demeanor seems to require the selflessness of a long-deceased saint.

Despite the challenges of modeling Dr. A’s style all the time, I believe that some of us practicing medicine could gain a lot for ourselves and our patients by attempting to do so. In my opinion, our patients would feel more at ease and more satisfied with our efforts to help them. They would probably be more likely to follow our medical advice. We doctors, I believe, would probably be more satisfied with our work as well. All because of treating them respectfully as though they mattered.

So, what I would like to know from you, whether you are a patient and/or a doctor: Do you feel respected by your doctor?

What specifically have you liked or not liked about how some physicians have interacted with you? What advice do you have for how physicians could improve their interactions with patients?

The author is a psychiatrist who blogs at Lockup Doc.

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  • http://bit.ly/7NzmlS Dyck Dewid

    It speaks loudly about you personally to open this topic in such an authentic way. My experiences have been mostly unpleasant. A few have been very pleasing. When I’m pleased I am always surprised. That tells something too.

    Rather that give specifics to a topic and an effort that is not at all new I’d rather refer to something valid (not data) with potential for leverage in you getting what you want as an MD.

    Two must read books: Kitchen Table Wisdom by Naome Remem, MD and How Doctors Think by Jerome Groopman, MD. The first is an easy read of short stories, non-fictional and tremendously engaging. The second book is also non-fiction and tremendously engaging due to its candor and honesty as a doctor.

    A must read interview by Sun Magazine, Then There’s The Doctors, is also very important to your discussion. Primarily a doctor who is trying to do the ‘right’ thing. It speaks for my personal experiences and I’m sure for others too. http://bit.ly/8I2pgS

  • http://obcookie.blogspot.com Elizabeth@obcookie.blogspot.com

    Hi Lookup Doc,
    Thanks for writing this great post. As a 4th year medical student I’ve seemed to notice a lot more than I used to the way that doctors treat me as a patient. I don’t expect special treatment as a student, but instead I expect to be treated as a patient, and not as a health care professional.

    I’ve felt more than once that the fact I was a student was abused. Once was by a dermatologist by first sneering at me when I said I was doing OBGYN and then spending the rest of the visit recruiting me for a clinical trial instead of talking to me about my skin. Another time, I had an awful headache for a week, which was causing considerable physical stress, and the first thing that the doctor said to me was “well what did you EXPECT ME to do about it?” as if I were supposed to diagnose and treat myself.

    I am grateful for those who doctors who walk through problems with me and we solve them together. Having a pleasant doctor’s appointment makes me strive further to continue to be a compassionate person. I realize more than ever what a big difference having open ears makes.

  • Sue

    At one time, it was very important for me to have a relationship with my doctor, especially primary care. I am very accepting of different personality types. I had a great relationship with a doctor with a personality of a door. But over the last 10 years, my relationship with my doctors has deteriorated. The main driving force was moving to an area where an urgent care section in my doctor’s office handled most issues. Instead of seeing my doctor several times a year, I was cared for by one of four nurse practitioners. During a 18 month period, I was seen by 7 different providers, not one of them was my primary physician. She remains a stranger. I wish I could go back to the door…at least I felt care for.

  • Trin

    Everyone is different so I figure that every doctor has people who like him and dislike him

    I am NOT someone who wants a chat doctor. I want to tell him whats wrong, have him help me, and allow me to move on. Many family of mine want a doctor who talks, chats, etc…

    I have a doctor that my family does not because I like the way he is no-nonsense about chit-chat

  • jimmy z

    I think that patient interactions should be paramount. I have been told on 3 different occasions that you can tell a “good” doctor by how thorough and extensive their notes are. Usually these comments are from some resident/attending physician with the personality of a tree stump and lousy bedside manner. Bedside manner and patient opinion should be paramount. Rather than spending 2 minutes with the patient and 18 minutes writing a note (which is long and painful to read ) it should be the opposite. I doubt the patient cares or reads the H&P, they just want a genuine, real person.

  • Finn

    I definitely feel respected by my doctors (internist, cardiologist, gynecologic oncologist). My internist doesn’t have time for chitchat but her attention to what I tell her and her willingness to discuss both treatment options and her thinking process make it clear that she both cares about and respects me. I get pretty much the same from the other two, plus an occasional sentence or two of chitchat.

    Other things I’ve noticed that they all have in common and that don’t take more than a second or two of time: They all knock and wait for my answer before entering the exam room, they all greet me by name and with a smile, and they all say something (like “And I’ll see you in 6 months but call if something changes or you want to see me again sooner”) as they’re leaving.

    It probably helps that I come prepared, with medication list, questions in order of importance in case we don’t get to them all, and symptom logs of the 2 conditions I’m being followed for so it’s easy to tell if matters are stable, improving, or deteriorating. I also smile and greet them when they enter and thank them at the end of the visit, and I’ve seen enough notes and referral reports to know that I’m usually described as “pleasant,” which I assume is code for “not a pain in the ass so don’t ignore her if she complains about pain or worsening symptoms.”

    I’d like to recommend another book: Only 10 Seconds to Care by Wendy S. Harpham, MD. It’s tips and advice for how busy doctors can manage, in only a few seconds, to give their patients compassionate attention as well as excellent clinical care. She has described it as written in a sort of “stage whisper,” intended for patients to “overhear” so they can understand the pressures their doctors work under and the things they can do themselves to help their doctors care for them.

  • http://imperturbabilityandaequanimitas.blogspot.com Michael Oleyar

    Recently I read an article about patients and physicians “speed dating” to briefly meet and find compatible matches. More programs like this should be implemented because it allows physicians and patients to choose each other based on shared interests. With a program like this patients might not have to schedule appointment after appointment just to find that “good doctor.”

  • http://bit.ly/7NzmlS Dyck Dewid

    Reading these comments has reminded (& got me a little fired up) me that on several occasions I have simply left an MDs office during or even before the completed intake by the physician. I feel perfectly justified in doing so because there is usually no accommodation to ‘select’ a doctor– no opportunity to meet the doc ahead of making an appointment to ask a few questions or have a short chat. This makes my first appt like a blind date. And it is occasionally a disaster. I know there are not many people with the inner authority I have. But, as a patient I have little else to get my message across.

    And I refuse to pay for services that are not what I want. A doc that doesn’t ask the right questions has no way of having the necessary information… then prescribes some pills or gives me some advice is useless to me because I won’t follow that advice or take those pills.

    Now, I often try to have discussion with the staff when I’m looking for a doc and think I can reasonably predict what the doctors are like by the people they employ and how the office is run.

    But, if I don’t like the way a doc treats me or she didn’t ask me WHAT I WANT, or ask me the right intake and diagnostic questions, or I think she’s being superficial or doesn’t have the wisdom to tell me what I heard, or shows disrespect or arrogance… I walk out and refuse to pay. And I’m angry that I wasted my time. And if I think it warrants I’ll write a comment on Angies List or if it’s bad enough I’ll write to the state agency or whatever I have to do.

    If I feel the doc is a menace I’ll go to quite drastic lengths to make trouble for them, as this is a threat to many people who are not warriors or don’t have much inner authority and who would suffer at their hands from mistakes like adverse drug reactions and missed important symptoms, humiliation, unnecessary or necessary tests and many other things.

    So, if I can’t find out ahead of time what I need to know about selecting a doctor, then I require a doctor find out what I expect. If we don’t meet purposes we have both wasted our time and should acknowledge this, and end the visit with the doctors apology and ideally compensation for my time. (I bet readers will react to this idea. But, see if you can notice in yourself why.)

  • http://www.brightonyourhealth.com Mary Brighton, MS, RD

    I remember reading once that patients get better faster if they think their doctor genuinely cared about their condition. I am sure this is true.
    Our doctor (we live in France) routinely spends at least a half hour with either me or one of my 4 kids during a consultation. I may go for a complaint such as ear pain + fever with one of my kids, but he takes time to see how everything else is going in their life. He weighs and measures them, he talks to THEM, not me, and he is also gentle with kids and whispers in their ear if he has to do something that might be frightening. He explains and shows them the shot if they need one…etc.etc.etc.
    He is also a homeopath, a general practitioner, acupuncturist…He takes calls on the phone and gives advice away with expecting payment for this later. We only see him, he doesn’t have a backup…If you call him and If he feels your case is urgent, he usually tells you to come in the same day and slips you in quickly between patients, explaining to those waiting in the room that it is only for a quick look.
    It seems like the old fashioned way, but it works for us…He knows my family and our habits. He always tells me that I am the expert on nutrition, (I am a dietitian) and he never trys to push that area.
    He is fantastic, and although we have to drive 20 minutes to see him (that is long in Europe) and we sit sometimes too long in his waiting room…believe me, he is worth it….
    Mary Brighton

  • Alina Shipman

    How about when the patient has to wait 45 minutes plus, just to see the doctor for 5-10 minutes. I find that extremly disrespectful, especially when the majority of practices are not open beyond 5:00 pm and most patients have to take off work. It’s like our time does not matter at all.

    Then, since the doctor can’t really find out what’s wrong with you during the 5 minute visit, either she/he sends to do a bunch of tests or you get some Rx that most lileky is not going to do much for you. So you’re left with trying to find yet another doctor hoping you could find a good one. It’s a completely frustrating cycle.

  • Ed

    My Primary is really nice but I recently found an amazing specialist. Somehow he set up his practice so that there is ZERO wait for your appointment. If the patient is late or blows off an appnt. the patient gets charged. The first visit he spends 45 minutes with you giving a thorough examination. By far the most important aspects to me are that he 1. Really wants to help solve my problem and 2. is up for the challenge of figuring it out 3. is open minded and 4. has a positive attitude. Yes, he costs more and it’s out of my own pocket but I need someone like a Sherlock Holmes that won’t quit a case till he solves it and enjoys the challenge. Still working on my issues but I’m hopeful.
    ALSO, his office doesn’t have one shred of pharma advertising in it which blew my mind. Maybe cause his office is connected to a hospital? Not sure. I’m all for drugs that help but sometimes too much pharma advertising is disconcerting to a patient.

    My worst experiences have been at derm factories. Let me guess Duac/Benzaclin, when that fails, antibiotic, when that ruins your flora Accutane. The factories look at you for a few minutes, write a script and that’s it. The docs are buried and don’t have time to care or even think through a problem. I mean did you really go to med school to write out scripts without thinking? Take some samples for chissakes and send them to a lab. or something . Paleeze.

  • Amelia

    DocA/F behavior? Have I got a list. NH patient.
    Doc 1/A/1960s: A relative, came to the house, was fabulous.
    Doc 2/3/4/5/F/1970s: Bad pain? Take ibuprophen.
    Doc 6/A/1980s: Fabulous, 1/2 hour discussion, ultrasound, finds the softball size tumor. 1 hour discussion about surgical options and informs me what to expect for my hospital trip. Angry with me that I haven’t been back for 2 years, I inform her her HMO says no appointments available as she’s part time. PO’ed, she’s working 60 hour weeks, eventually quits.
    Docs F/1990s/first half of 2000s: Down to 2.5 minute appointments. I’m fairly certain at this point patients are viewed as specimens or amebas, assuming it must be part of their medical training as it’s persistent at this point. 2 week wait to hear the breast lumbs are benign. “Oh yeah, I wanted to get a hold of you before I left for vacation.” More abdominal tumors found, 1 minute discussion “You need a hysterectomy, call me to setup surgery when the pain gets bad enough.” Websearched to find Doc 6, retired, referred me to…
    Doc A/2007: Fabulous, 1 hour discussion of options, laproscopic myomectomy, home in time for dinner.

    Two thoughts: 1) Recently I’ve come to the conclusion southern NH HMOs have crushed doctor/patient relationships as I’m having better luck in MA (Doc 6 and 2007). 2) I am embarrassed at how poor the bedside manner of most Docs is. Inhumane. Busy? We are too, and we recognize when you’re having a bad/off day. But you know your Doc F was like that every day. I love Doc 1, 6 and 2007, truely, I love who they are. As for the rest, I range from sympathy to disgust.

    Advice? Look your patients in the eye, ask what their symptoms are, look at them when you’re listening, tell them what you think is the problem and what their options are, all of them, including options you personally can’t perform. My favorite doctors are not taking notes while I’m talking nor while he/she’s talking. Let a patient know when they can hear results. If you’re late, acknowledge it, we know it happens (we know you’ll be there for us with the extra time if/when we need it). Courtesy 101.

    If you’re asking these questions, you’re a Doc A even if you feel like a Doc F some days. By the way, some people like Doc F, the self-conscious and those who don’t want to make any decisions about their care. They actually prefer the emotional distance of Doc F, easier to forget about when you leave their office and too intimidated to make any health decisions.

  • Christina

    My regular doctor is pretty good about making me feel comfortable. My general thought on how doctors in general could be better….

    Listen to me. Remember that I’m not completely stupid. Before you dismiss my opinions on my condition, think about the fact that I might’ve spent hours researching it, and maybe come across some useful information. If what I’ve brought you isn’t good information, briefly explain why.

    I personally think my regular doctor is overworked, so I wouldn’t blame him if he wasn’t exactly gregarious on a particular day. As long as he’s polite I’m happy.

    I visited one doctor who was pretty much completely the opposite of my regular doctor. She was polite enough when I came in, but when I described my problem, and proposed a solution that I had researched, she completely blew it off by saying she’d never seen it before (and therefore was not possible, I guess?) I saw her a handful of times, she ran a few tests (one of them actually did lend credibility to my argument), and then she told me she had no idea what my problem was, and proposed sending me to a specialist. Meanwhile, my regular doctor had seen enough evidence from me that he agreed with me on what was causing the problem. I went with his prescribed plan, and started improving over the next couple of months. I’m nearly 100% better now.