You can’t legislate doctor-patient relationships

I was on call this past weekend, rounding at about 8am on the cardiology floors, and a woman I didn’t recognize approached me.  She asked if I remembered who she was, and was quick to tell me that if I didn’t it was ok.   She had had bariatric surgery about 6 months previously, and I had seen her in the office for a pre-surgical consultation.

She went on to tell me that she had lost 80 pounds since her surgery. She no longer had diabetes, and was no longer on high-blood pressure medication.  Her cholesterol levels had fallen in half, and she was now exercising every day.

And then she did something unexpected:  she thanked me for talking to her when she had her office visit with me six months earlier.  It turns out she was initially very hesitant to have the procedure done.  She didn’t want to go through all the “hoops” that her doctors, and insurance company, required prior to having the surgery (by the way, a visit with a cardiologist to ensure that her heart was healthy enough to have the surgery was one of the hoops).

But we sat and visited, and although I don’t remember the conversation at all, she told me that my taking five minutes to talk with her — instead of clicking boxes on the computer, or instead of rushing her out the door — made all the difference, and guided her towards what she needed to do to take care of her health.

There are a multiple different lessons from this anecdote.   Among the most important is the knowledge that what we as physicians say and do, and how we say it and do it, matters.  It’s not just the medical knowledge, although sharing with her the benefits to her health over the long term of controlling her weight, diabetes, hypertension and hyperlipidemia did influence her decision.   But it’s the manner in which information is conveyed, and the place, and the timing.  It’s little things like turning away from the computer and looking someone in the eye when talking with them.  It’s treating people with respect, courtesy, and as equals, not as yet another number to move through the office.

I think about how our “health care system” is trying to rearrange itself, and wonder what will happen to encounters like this.  Most physicians enter the field of medicine because it gives us a chance to give back to others what we all have most likely been given at some point along the way.   And although the current checklist paradigm of making sure that the basic things are done right (e.g. treating blood pressure and diabetes to appropriate targets to minimize risk of future adverse events) helps us as physicians focus our efforts onto prevention and disease management, our method of doing so matters.

Would a web-based form or a self-assessment tool or a phone call to a nameless person hundreds of miles away had the same effect for this patient as our face-to-face encounter did?   If I had simply clicked my through the required boxes on my EMR template (which are required not by me, but by Medicare, so that I could get paid for the time I spent with her), would the outcome have been the same?  She was reassured precisely because I wasn’t a provider or communicator or technician or a computer entry specialist, but rather a doctor, a physician, and because I took five minutes to act like one.

Ultimately medicine is about people and about relationships.  You can’t legislate relationships.   You can’t put a price on it.  You can’t figure out how to reimburse it or how much each minute of that relationship is worth.  It’s hard to imagine that if we could do a better job on our end, and that if they — the payors and regulators and legislators – would let us and require less administrative work, that the end result wouldn’t be the type of health care system that we all are hoping to achieve.

J. Russell Strader is chief, cardiovascular services, the Medical Center of Plano.

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  • Dr. Drake Ramoray

    I agree with this post. However with ACO’s and PCMH and new meaningful use requirements and EHRS requirements I think we are learning you can legislate the doctor patient relationship away.

    • rbthe4th2

      Hmmm not sure Dr. Ramoray, maybe you medical professionals and we patients can figure out some way to get past the govt. “hoops” and come up with something we can both deal with.

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