Physicians and health care providers across the world are trained to treat disease processes and disease states. Often, this approach becomes technical. And while directed towards the patient, it paradoxically distances itself from the patient. The distance created between the patient and the physician through diagnostic and therapeutic approaches is related to the patient’s dissatisfaction with their medical journey.
Being sick and ill, whether it is a major or minor illness, is a truly unpleasant experience. From the simplest to the most complex diagnoses, patients inherently feel vulnerable and insecure in the health care setting.
My wife and I are both practicing physicians. While we have not been significantly ill in the past, we certainly are rapidly learning and reflecting how to deliver better patient care.
Most recently, my wife was a patient, ultimately requiring emergency surgery after being followed for about five days prior. While surgery may not have been avoidable, the route to get to the point of emergency surgery was like navigating rough waters. We felt alone, vulnerable, at-risk and scared. I converted from a calm and compliant family member to one that was stressed, assertive, and unpleasant at times. My wife had surgery and recovered well. It was only during the hours around the surgery and after the surgery where we truly felt taken care of.
We are fortunate that she is healthy now. As we move forward in our lives, I have realized that there are a few core things that patients need and benefit from in their vulnerable states. I now continue to try to encompass these behaviors and values in my daily interactions with patients.
1. Approachability. This is a fundamental behavior taught on many levels to all health care providers. But time and time again, even the most fundamental behavior demonstrating a care team is approachable is missing. It can be a smile, addressing a patient by their name, shaking hands or even sitting down with the patient. Demonstrating approachability at the beginning of an encounter is the most crucial time. Without approachability, trust is lost. As physicians, we should make sure our multi-disciplinary care team understands this as they can serve as the face of our practice in many instances.
2. Communication. We must be able to communicate effectively and with confidence with a patient and their loved ones/advocates. We live in an era where information is easily accessible on the internet. Day to day, Physicians may be plagued with the pressures of seeing more patients during a day or adhering to a length of stay parameter for a hospitalized patient. But taking the extra time to communicate the care plan is the core for navigating a patient. And a vital part of communication is to assure that a patient’s questions are answered. Take time to ask: “What questions do you have?” No matter how smart or health care savvy we are, there are always questions. Patients also want to know the results of their diagnostic tests. I remember waiting all afternoon to hear from a provider on the next steps of a STAT imaging study that my wife had completed. We were hanging on to hearing what to do next and felt lost waiting as there was no clear communication after the procedure.
3. Acknowledgment. Patients are eagerly awaiting to see their physicians and providers to determine the next steps in their journey. While physicians are constantly being pulled in different directions, having a prompt ability to respond and acknowledge a question or inquiry significantly helps a patient. In the days of EMR and portal messages, sometimes patients can feel as if their questions are being submitted into space. For example — even if a physician does not know the answer to a question posed by a patient — a simple, “We received your question, and do not have an answer yet. We are working on it, and will be in touch as soon as possible.” This statement helps the patient gain some trust in the system that their issue is important, and it will be addressed.
4. Validation. Patients need to feel validated. They feel vulnerable and insecure. When my wife was ill, I felt the most vulnerable, scared, and had a lot of questions. Patients will ask themselves if it is OK that they are asking about their pain, or if it is OK that they’re feeling scared about the results of a blood test. Take time to validate their concerns. It is refreshing for a patient to hear, “What you have been going through is very stressful, and you being here is the first step for us to figure things out.” Or “You’re absolutely right. We need to work this up and get some testing done.” When a patient is validated and feels “correct,” they are feeling more empowered and trust in the system, and with us as physicians.
5. Personal connection. The doctor-patient relationship is built around trust. While we must maintain boundaries with patients, there are simple ways to help establish a better personal connection. I have found that discussing components of a patient’s social history can really help with this, and it can take less than one minute. For a patient who is retired, inquiring about what they did before retirement can be a huge avenue for connection. I have found that so many of my patients have had amazing careers such as teachers and pilots, among other things. Asking about family (including children or grandchildren) can bring joy to a patient and help establish a personal connection. The social history for a patient is vast, but even a small part of it can serve as an avenue to find a commonality with a patient on a personal level.
Overall, taking care of patients is truly a privilege. We must continue to embrace ourselves and our roles to deliver the best patient care possible. It can be challenging at times. If we reflect on personal experiences and practice behaviors and values that can facilitate the best patient experience — then the patient will ultimately be the most satisfied in their state of vulnerability and stress.
Dhaval Desai is a hospitalist.
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