The doctor-patient relationship with dying patients

Perhaps we thought we could get away with ignoring the relationship between doctors and patients. The Kaiser Health News article, “Efforts to Instill Empathy Among Doctors is Paying Dividends,” explains why we can’t.

Patient satisfaction scores and reimbursements aside, this relationship was once considered the cornerstone of quality care.

Doctors are healers but in recent years many have been reduced to diagnosticians, electronic medical records (EMR) data entry clerks, and health insurance appeal wranglers. They are so much more than that, but with 7 to 15 minutes per patient, it’s a challenge to fit in what used to be an intimate relationship with patients.

The changing face of health care has whittled down doctors’ relationships with patients to close encounters-of-the-impersonal kind. Physicians are fleeing their practices, selling them to hospitals, moving into concierge medicine, and more. Many are frustrated with how healthcare has changed the way they practice medicine. Some have found ways to salvage it.

A physician friend recently revealed to me that she doesn’t leave her office until 7:30 or 8 p.m. each night because of the EMR data entry program dictated by the hospital corporation that purchased her practice. She now has massive computer screens in each exam room. In her office, a towering computer screen looms over her desk. Seated in her once-comfortable office, I was startled by its presence.

With a sigh, she said, “It takes so much time to input patient information into the computerized forms. I can’t just type it out. I’m pigeonholed into forms and boxes that don’t allow me to just type in notes.”

With a dying patient, I wonder how much time doctors have to spend listening, waiting for patients to ask the questions instead of harnessing the conversations with their own. Atul Gawande so poignantly pointed out in his PBS/Frontline interview, Hope is Not a Plan, that conversations about end of life must include sitting with patients to allow them the space to reveal what is most important to them in their final days.

Dying is a lonely business for patients, which is why Jeremy Force, the first-year oncology student from the Kaiser Health News article, was so important to the dying cancer patient. He allowed for meaningful impact with that patient just by being present, by validating her experience, listening intently, and offering empathy. If that wasn’t life changing for him as well as the patient, I don’t know what is.

Jeremy Force used strategies he’d learned in a day-long course by Oncotalk, which is required of Duke University’s oncology fellows, as well as by University of Pittsburgh and several other medical schools. Dr. Force acknowledged what his patient was going through, provided empathy and employed active listening skills. In essence, he paved the way for the all important doctor-patient relationship.

A few days later, Jeremy Force ran into his patient in the hall of the hospital. She conveyed her appreciation and gratitude for his approach. The key, of course, is Force as a human being, ultimately revealed by his response. He said, “It was an honor.”

Maybe all doctors and patients can learn from this, push for the relationship between doctors and patients to be valued over data entry and reimbursements. We have to try.

Martine Ehrenclou is a patient advocate.  She is the author of Critical Conditions: The Essential Hospital Guide to Get Your Loved One Out Alive and The Take-Charge Patient.

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