The Human Connection

Establishing a trustworthy doctor-patient relationship is the absolute key for the successful management of EVERY condition we treat, while it simultaneously creates the advantage of reducing medico-legal liability! While one cannot promise nor predict that one will never get sued, despite our best efforts at communicating and providing the highest quality medical care available, those health care providers that are trusted by their patients stand the greatest chance of avoiding malpractice law suits. I believe I'm in the rare but enviable position of speaking on this issue, for in 20+ years in private practice, I've never been named as the primary defendant in a malpractice case. To that end, what I've learned is that even more important than patient education is patient CONNECTION, and I believe the single most important aspect is to create the aura that you sincerely care about your patients and wish to treat them as you would your best friend or family member. How does one go about establishing this connection?

Making the Connection

Anatomically, the human brain has two distinct hemispheres. Before one can successfully attempt to impart information to the brain's cerebral cortex (cognitive side), one must first connect with the midbrain (emotional side). Initial greeting, patient eye contact, body posture, utilization of non-verbal communication skills, active listening skills and displaying empathy towards one's patient all work to establish trust which is an emotional response to visual and verbal stimuli. My partner (PRESENT Author and Lecturer John Guiliana, DPM) once informed me that communication experts agree the impression one creates in the first 10 seconds of an initial patient encounter may last as long as 5 minutes...so, clearly, the MOST important part to the start of establishing a strong doctor-patient relationship is one's GREETING. Displaying a warm, friendly smile while offering a firm, confident handshake and maintaining eye contact from the moment you walk into the treatment room are the hallmarks for a successful greeting. Assuming proper posture and immediately focusing on your patient imparts an attentive and concerned aura. Breaking the ice with an initial question such as "did you have any trouble finding our office?" often takes the edge from nervous patients. If you want and expect your patients to reveal truthful and accurate information about themselves, to comply with your various treatment recommendations, then mastering these skills becomes essential in obtaining successful treatment outcomes.

Establish the Case that You Care about Them, Not their Condition

Asking early social open ended questions (those that do not evoke simple yes and no answers) allows a patient to talk about themselves. People enjoy this and it shows individuals that you care about their lives, rather than being looked at as just another statistic. It also provides the health care provider insight into the patient's socio-economic status and education level. These factors are important to establish before one begins the process of querying for answers to medical questions because it provides insight into how detailed and sophisticated the communication can become and thereby sets the communication tone. For example, an open ended social question might be...so Mrs. Jones, would you please tell me a little bit about yourself (family, personal likes, dislikes, employment, where raised, etc)? This typically takes just a few minutes, but once accomplished, further connects with the brain's midbrain. Now, you've laid the foundation for creating an aura that you are interested in this patient as a person. When patients FEEL that you care about them, they're more apt to open up to you and provide you with the information you need to establish a working differential diagnosis and subsequent treatment plan.

Now You're Ready to Listen

Now, you should be ready to take an accurate and thorough history of the patient's chief complaint. Here, a combination of open and closed ended questions may be utilized to disclose the NLDOCATs pertinent to the patient's chief complaint (Nature, Location, Duration, Onset, Course, Aggravating factors and Time). Try to avoid using leading questions. Rather, let the patient tell their story. Keep your language commensurate with your perceived patient comprehension level. If you use medical terms, briefly explain them. If you find a patient begins to ramble off on a tangent, a gentle touching of the foot or leg combined with a phrase such as, "please excuse my interruption Mrs. Jones, but I think it would be most helpful if WE (evokes a sense of a "medical partnership") refocus on…." As you get farther and farther into the history taking, you can then begin to ask more closed ended questions that evoke the most rapid replies to provide the various essential details surrounding the patient's chief complaint. Out of all the components of the initial examination, one should take the most time taking the history, for the diagnosis can generally be made 9 times out of 10 before one even touches or observes the foot. The physical examination is then utilized to corroborate the initial clinical impression arrived at from the history. Usually, this proceeds rather rapidly, for one is usually able to isolate the complaint to one of the major bodily systems i.e. vascular, orthopedic, dermatologic etc. and can quickly hone in on evaluating whether the various signs commensurate to that suspected diagnosis are present. Once this is performed and the diagnosis corroborated, then the ensuing educational discussion regarding the chief complaint and its treatment protocol(s) may commence.

Doctor = Teacher    Art, Not Science

When imparting medical information to the patient, never talk down to them. Display empathy with expressions such as, "Wow, I can see how this problem must really affect your lifestyle, and I believe we can work together to get you well", and/or, "I believe I understand what you are going through and will do everything within my power to help you get well, but I'm going to need your help." Expressions like these not only display a caring and empathetic attitude; they are also designed to create a cooperative between doctor and patient. Patients are more apt to comply with treatment recommendations if they are "led to believe" they are taking an active part in the decision making process. The art in medicine is through empathetic communication where patients think the treatment they are about to submit to is their idea! While offering treatment options is always the best policy, occasions often arise when one specific treatment protocol is clearly superior to all others, and therefore, in the patient's best interests. If a patient initially fails to agree with that treatment recommendation, a phrase such as "Mrs. Jones, in my experience, for your complaint, this treatment recommendation is clearly your best option, one that I've witnessed the most successful outcomes with, and I have no hesitation recommending it to my best friend or family member." AND, by the way, as previously mentioned, and it bears repeating, if you treat your patients as you would your best friend or family, you will ALWAYS succeed!