Most patients think they need to come to their doctor’s visits with a strict agenda. It’s a habit forged out of wanting to get quick fix and a by-product of time constraints. This paradigm seems logical and can sometimes accomplish its goal, but too often, this approach falls short in harnessing the immense value that can result from a connected physician-patient relationship.
I can vividly remember the days when the idea of asking any questions other than those that addressed immediate symptoms (but that might lead to larger health revelations) seemed almost a nuisance to the patient.
Now, as a doctor making house calls that last as long as the patient or I need, I’m aware more than ever how rushed and impersonal visits shift the conversation with the patient into an interrogation, thereby significantly limiting the possibility of discovering a long-term solution to the patient’s health and well-being.
When I get sick, I’m forced to take off my white coat and put myself into the shoes of the patient. I can appreciate the urge to have a hyper-focused conversation. My hurried lifestyle pushes me to resolve my immediate health issue quickly so I can get back to my daily duty.
But new technologies as well as emerging values around the definition of effective health care are empowering physicians like myself to get back into the business of healing a patient with more time and convenience that create a space for truly health-altering conversations.
Recently I visited a busy mother who thought she might have strep throat (the patient has given me explicit permission to include details from her visit in this column). While this visit could have been a brief evaluation so that she could return to her endless duties as a mother, the patient was surprised I wasn’t in a rush to leave her, and she started to lean into the visit with albeit incredulous tone as we discussed her life, what she’s enjoying about her days and what are common stresses.
The result was a relaxed conversation that might forever improve her health.
Why? Because toward the end of our chat, she remembered she had been diagnosed with gestational diabetes just before her second son was born five months ago. She had been so busy with her children that this very important piece of information had slipped her mind and she only just remembered the diagnosis. I explained that gestational diabetes significantly increases the risk for developing chronic diabetes and advised she get lab testing for surveillance. She now has a plan to take preventative measures as opposed to treating symptoms once they present. This shift towards being proactive instead of reactive is the mantra of modern medicine.
Dr. Eric Topol, a health-technology visionary, recently interviewed bestselling author Malcolm Gladwell who emphasized the value of time and context of physician-patient interactions. Gladwell opines that patients want a physician who can have conversations with them explaining their health and helping them navigate the health care system as it becomes increasingly complex. He posited that if physicians are not provided the time for these conversations, then we will have “brilliantly gifted doctors” who won’t be given the chance to convey their knowledge.
Paul Grundy, IBM’s Director of Health Care Transformation and founding president of the Patient-Centered Primary Care Collaborative, has studied the value of a strong connection between the physician and patient as highlighted in a recent article by KQED’s Christina Farr:
Grundy’s research from 2008 found that those who have a regular relationship with a primary care doctor, or “healer” as he calls them, cost the health system one-third less and experience a 19 percent lower mortality rate over a 15-year window than those who can’t name their primary care doctor.
In her piece, Farr also took note of a familiar story I frequently experience with patients who take the time to choose a physician who will “spend time really listening to her, rather than staring at a screen or hastening her out the door after a few minutes.” The patient in her article emphasized the importance of the physician “being open and honest, hearing my worries and thoughts … I do not expect to be rushed.”
A visit with a physician should be centered around this conversation. When patients feel more at ease, as they do in the comfort of their home, I see them speak more freely and respond more openly to having a dialogue that is proactive about their health care maintenance and long term health.
Matthew Walvick is a physician.