Researchers who conducted interviews a few years ago with 192 patients at the Mayo Clinics in Scottsdale, Ariz., and Rochester, Minn., identified seven “ideal physician behaviors.” Patients want their doctors to be “confident, empathetic, humane, personal, forthright, respectful and thorough,” the researchers wrote in Mayo Clinic Proceedings in 2006.
At the same time, of course, patients want their health problems properly diagnosed and competently treated. How, in the course of the 15 minutes that the typical patient gets to spend with a doctor, can all this happen?
With doctors increasingly pressed for time, how can they offer both the clinical expertise and the compassionate care that all patients deserve? And what can patients do to get what they most want from their doctors?
Building Trust
In her new book, “Only 10 Seconds to Care: Help and Hope for Busy Clinicians” (ACP Press), Dr. Wendy Schlessel Harpham combines her experience as an internist and her nearly 18 years of experience as a cancer patient to show how simple actions and well-chosen words on the part of medical professionals can make an enormous difference in a patient’s emotional and physical well-being.
Dr. Walter F. Baile, a psychiatrist at the M. D. Anderson Cancer Center in Houston, said in an interview that the book was replete with “clinical pearls — succinct ways that physicians can affect patients’ well-being and make them feel supported.”
Building a patient’s trust and confidence, he said, is healing.
Many studies have shown that when doctors provide compassionate care, that increases the likelihood that patients will follow medical advice and practice self-care, which in turn reduces complications and their need for repeated treatments and costly hospitalizations.
Larry B. Mauksch, a specialist in doctor-patient communication in the department of family medicine at the University of Washington in Seattle, urges doctors to build rapport with their patients by greeting them warmly by name, asking briefly about important events in their lives, maintaining eye contact, focusing on the patient without interruptions, and displaying empathy through words and body language.
To make the most of each visit, Mr. Mauksch suggested that doctors first ask about patients’ concerns and then focus on just one or two of their most pressing medical problems, saving others for later visits.
Keeping Hope Alive
In her book, Dr. Harpham writes that dealing with patients’ emotions “is a vital task for healthcare professionals.” She applauds the response of an oncologist who said, after the first of many recurrences of her cancer, “I can only imagine what this feels like, but I’ll do all I can to help you.”
Dr. Baile cautions doctors against trying to “fix” the emotion when bad news upsets a patient. Rather, he said, “they should empathize and align with the patient and say something like: ‘I can see you weren’t expecting this news. I understand that you’re upset by it. I’m disappointed too that we didn’t get a better response to the treatment.’ ”
Dr. Harpham said there was a world of difference between “if” and “when” in discussing the chance that cancer will recur. The word “when” is a prediction of doom that can make it difficult or impossible for patients to find joy, she said.
“In contrast,” she writes, “a prognosis preceded by ‘if’ introduces uncertainty. This hint of possibility encourages patients to strive for a balance of hope and acceptance that helps them work and play, laugh and love in the face of a fragile future. For patients to be free to find the balance that helps them live, the door must be left open for them to find hope.”
Rather than focus solely on the expected outcome when a prognosis is dismal, Dr. Harpham urges doctors to “share both your expectations and your hopes with your patients.” She says that “people can expect one thing and hope for another” and reminds health professionals that they are “obligated never to extinguish hope.”
She concludes, “We foster hope by telling patients that we are prepared to care for them through the likely outcome and are hoping they make an unexpected and inexplicable recovery that proves our prognosis wrong.”
As Mr. Mauksch put it, “The physician’s commitment is not just to cure but also to care.”
For physicians who need help in developing effective communication skills, Dr. Baile’s medical center has created a video library at www.mdanderson.org/icare.
How Patients Can Help
Because time is short in any medical visit, it is often up to patients to prepare by writing down their most pressing concerns and questions.
Dr. Baile advises patients to gather some information about their disease and its treatment before seeing the doctor, but not to “oversearch.” Too many statistics and case histories can be overwhelming, and all that information is useful only to a point: each case is different, and each patient is different.
Patients should ask the doctor in advance whether they can record the conversation. It is also helpful to take along a relative or friend who can take notes and ask relevant questions. One study found that when patients had someone to help them talk with their doctor, they were more satisfied with the information they got and with the doctor’s interpersonal skills.
Mr. Mauksch said patients could help set an agenda for a medical visit by saying upfront, “I need you to know what I’m going through and what my questions are.” If not, he said, doctors will fill the time with information that is not necessarily what concerns the patient, who may be more worried about how she will look after treatment than about details of the pathology report.
Before leaving the doctor’s office, patients should make sure they understand the instructions and treatment plan, including what they should do to take care of themselves and when they should contact the doctor about side effects or new developments.
For questions that come up after a visit, Dr. Baile suggested that patients ask about the best way to contact the doctor. Many doctors today communicate through e-mail; others use nurses or midlevel practitioners, he said.
Most important of all, perhaps, is for patients to be honest and forthright. Too often, patients withhold critical information or lie because the truth is embarrassing or because they don’t want to disappoint the doctor by admitting that they did not follow the advice or the precise treatment plan.