Focus on the Mission, Not the Score: Healing the Doctor-Patient Relationship

I recently read a post entitled “Patient Satisfaction and Doctor Requests – What’s the Score?” The post addressed the patient perception that doctors are not empathic and the physician perception that patients want to get what they want in order to be happy with their care. The content of the blog post notwithstanding, the phrase “What’s the Score?” is really what stuck with me.

What is the score?

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If this is a fight, it is an unfair one with unfair rules. The doctor-patient relationship in its current state is like a marriage fraught with miscommunication, assumptions, and unspoken expectations. And let us not forget third- and fourth-party intruders (including insurance companies and administrators who push for productivity). The encroachment of these groups has put a strain on the original partnership.

One of the reasons I started this blog was to get back to the things about medicine that inspired me during my early years of training. I have had a relatively short career, so I am almost embarrassed to admit that there was a point shortly after residency that I felt I lost the meaning of being a physician. This was a time where I was seeing a large number of patients a day, not to mention all the other non-clinical –but just as crucial- work that was not built into the schedule and some life stressors that were going on at the time. There was no breathing room or bathroom breaks (and I am being literal about the latter, not the former). I believed that I was an empathic and capable physician, but I also knew that my interaction with patients was far from ideal during this time despite my best ability to stay afloat. Luckily, circumstances around scheduling patients changed in my office for unrelated reasons and things improved just enough for me to say to a clinic administrator “I am finally feeling like the doctor I have wanted to be.” Don’t get me wrong. I was still ridiculously busy, but not stressed to the point of physical, mental, and emotional exhaustion.

In some ways, physicians are functioning as skeletons of what they intended to be in our current healthcare system. I was a good example of this. I do not know any doctor who would not prefer to spend more time with their patients and be able to tap into their own empathic side. But the truth is that things like LDL goals, weekly visit numbers, and CPT codes are the measures that are valued because they are tangible and because practicing medicine in this country is still a business, after all, not a charity. So physicians working in cognitive specialties (like primary care) are trying to keep up with demand, working faster and smarter, pushing their neurons to the limits. How is this not going to translate into the interaction with patients?

Receiving sympathy from the general public is not my point here. What would be better is an understanding from both sides. So I cringe at comments and posts that pit doctors against patients. Patients do this. Doctors do this, too. And when doctors make certain negative comments online (mostly anonymously), I find it embarrassing to my profession. But I also know they do not do this out of malice. There is something seriously wrong with a system that turns a bright, well-intentioned, caring, and naively optimistic group into one that finger-points at the very people they aimed to heal.

I unknowingly embarked on a mini-mission to repair the doctor-patient relationship when I started to write this blog. My hope is to educate and inspire and to collaborate with others who have the same goals. As part of this mission, I am also hosting a movie event that is open to the public. It addresses some of the lesser-known aspects of practicing medicine that contribute to a physician’s burnout and will open your eyes to why some well-intentioned doctors are leaving the field. 

Remember, what both sides are really lamenting in our current healthcare system is the relationship that they hoped they would have. Ultimately, patients and doctors want the same things. We also both want this “marriage” to work and to have a long-lasting and mutually fulfilling partnership. With the right perspective from both sides and emphasis on the most important aspects of care -not the codes, visit numbers, or provision of unnecessary treatments and evaluations – it can be a win-win for both.

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About Linda Pourmassina, MD

Internal Medicine physician.
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6 Responses to Focus on the Mission, Not the Score: Healing the Doctor-Patient Relationship

  1. eric says:

    Im not a physician but from a patient perspective I can say that patients can do more to strengthen the relationship. I’ve been seeing my pcp for 20 years, I caught him from a bright energetic young man eager to address every problem down to small scrapes of childhood to a malingering man who can’t soon enough retire.
    Just like your allusion to the interaction between doctor and patient being essentially a relationship, what kind of relationship can survive when one party cares and completely listens to the other without any reciprocity or gratitude. I started sending this physician thank you letters to his office, started connecting with him about his own life – asking about his sons who went to school with me – and generally showed him appreciation for the care he provided me and letting him know it was having an impact on my life. I can’t say I changed his overall demeanor but I noticed he smiled more during our visits and seemed much more empathetic and interested in my treatments. Honestly I think doctors are much more sensitive emotionally than the general population. They have a strong capability to have empathy but their emotions are organic, and are thus bound to the laws of emotions. And as much as doctors try to elevate their emotional centers to a business like professionalism able to be summoned by will they find the brain doesn’t work like that. The brain will give you the emotions and empathy if it is genuinely existing. And in order to be genuine the relationship needs to be genuine. And its just hard in an environment where doctors are more likely to be sued by their patients than receive a simple thank you letter. And doctors can try to fake the motions of empathy to guide them through treating their patients but its always altogether obvious when they’re winging it. Its like watching an explorer navigate through a thick fog with a false compass. A doctors compass is their empathy without it they will always be lost and its up to the patient as much as the doctor to maintain it.

  2. Paul Constantine says:

    As a patient for the past 8 years at the Polyclinic, I have been impressed with how much time and empathy I receive from my physician. As the son of a small-town country doc from a previous generation, I know how the health care industry has changed over the years–in many ways for the worse. But, I treasure my current doc and hope that he’s around for many years to come.

    I also enjoy your blog very much–thanks for keeping it up!

  3. Linda,

    I like your blog and your post…not just because you referenced one of my more recent posts. I think you are right about the fact that patients are generally unaware of the pressures that physicians operate under. But then patients don’t feel that their physicians really don’t understand or appreciate their (the patient’s) dilemma either.

    What I am trying to accomplish with my blog Mind the Gap is to suggest to physicians and patients that there 1) is a problem and 2) that practical solution are out there if we look for them. I have spent the last couple of years reviewing the literature on the subject of physician-patient communication for example and I am astounded by the number of evidence-based solutions I have come across. I am particularly intrigued with interventions directed at teaching patients how to “become better, more productive patients.”

    I too am looking to collaborate with primary acre physicians interested in doing what we can to strength the physician-patient relationship. We should talk some time.

    • Steve,
      First of all, thank you for your blog posts, which do help point out some of the challenges in medicine today. I agree that physicians can do more to understand their patients. I may be speaking for myself here, but I really think they have wanted to get to that point of really listening, which leads to understanding. I myself found that within a certain environment, I was “hearing” patients, but ran out of time to actually “listen” amongst the extraneous noise. You are correct in stating that we need practical solutions. We need to identify the barriers, as well. So I would certainly be interested in hearing your ideas. My personal approach so far has been to try to inspire physicians and nonphysicians by way of this blog (which is definitely work in itself), using healthcare social media, getting involved in my local community and in the American College of Physicians (the Women in Medicine group of the Washington Chapter). Negativity is infectious and rampant when healthcare is being discussed. I am hoping to be a more positive voice in the healthcare social media front.

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