Medical Schools Teach Value of Patient-Doctor Relationships | Education
It is not uncommon for patients to be afraid to tell their doctors the truth.
Maybe it is about drug and alcohol use or sexual concerns. It may be that they didn’t get a prescription filled because they didn’t have the money, or simply forgot. Perhaps they had the medication but didn’t take it or didn’t like how they felt after taking it, or they wanted a different medication that the physician felt was potentially addictive. Or maybe the patient believes their doctor will be angry or disappointed in them.
The bottom line is that the doctor will have no idea why the treatment failed and the patient isn’t progressing.
On the flip side, a positive, caring and trusting relationship allows the patient to give you, their physician, the whole story, even if it isn’t pretty. If the patient trusts you enough to share their hidden concerns about what caused the problem, the actual amount of the medicine they took or the guilt they feel over causing their own problem, you will be far better equipped to help them.
A strong, healthy patient-doctor relationship is still vulnerable to bumps in the road or flaws in both the physician and the patient, but it’s likely to weather them. Neither party wants to let small imperfections get in the way as long as it is clear you are working as a team for the benefit of the patient’s health.
If the doctor runs late but patients know the physician will give them the full attention and care needed, they will generally look over it. The physician may make a mistake, admit the error and express true remorse. Patients, in my experience, are grateful for the honesty and don’t want to lose their connection for care.
Given the importance of this relationship, medical schools spend a lot of time helping students learn to develop the skills necessary to make successful relationships with their patients.
Perhaps you witnessed this in action when you shadowed doctors as an undergraduate. Observant students frequently write about this in their essays on the medical school application.
Doctor Shadowing Is Invaluable
One of the truly great physicians and teachers, Dr. William Osler, would say something to this effect: If you want to know what‘s wrong, just listen to the patient. If you have shadowed a doctor, you may have watched this unfold in real time. Active listening, eye contact and expressions of empathy are key.
Watch carefully how doctors greet patients. Do they express warmth or show evidence of true caring? How do they ask questions that allow the patient to tell their story, just like Osler recommended?
During the past two years of COVID, many med students had to shift shadowing to a virtual format, which is better than nothing but not as helpful as actually being involved in the experience in person.
I always suggest students start asking about shadowing opportunities soon after they arrive at med school so that they can observe many different specialties and not wait until clinical clerkships start. Ask the student affairs dean, your adviser, or a fourth-year student for suggestions about who to contact for shadowing.
For physicians who don’t see patients for very many minutes, how do they accomplish building a bond with their patients? Ask them about the challenges they have observed when trying to build a new relationship. The more different experiences you have with diverse specialties, the easier it will be for you to make up your mind when the time comes to decide what is right for you.
Med School Courses and Clinical Clerkships Teach Skills
The standard medical school curriculum will have built-in communications classes with standardized patients who are actors. This is very different from typical shadowing with physicians on the job and real patients. Standardized patients are coached to represent patients with particular conditions, moods or personality characteristics.
This experience is set up to let you feel what it would be like if you were taking care of the patient yourself. You may get the opportunity to build a relationship, then have to tell the patient there was an omission or error that occurred in their care. How would you approach a patient who has a terminal illness? There is much to learn about relationship-building during medical school.
From outpatient clinics and teaching patients how to prevent illness, to acute emergency care for a patient newly admitted to the hospital, you will have guidance and time to ask questions of your teachers about the strengths and challenges of the patient-physician relationship. Many of these occur during the clinical clerkship year beginning the second half of Year 2 or the beginning of Year 3.
How does the physician review the chart before going in to meet the patient? The more a doctor understands the purpose of the visit and what information the patient has already divulged, the better. The chart helps the physician understand how the patient has dealt with a health concern and what limitations to their life they have experienced.
Do you ever recall a time when someone interviewed you without checking your chart or reading your application? It can feel like you are not important enough for them to take the time to get to know you. That’s not a good way to build a relationship.
The patient may feel the doctor doesn’t care enough to understand what they have been through in the past. By careful observation, you can learn better ways to begin a relationship as well as tactics that are less than optimal.
A patient does not want to be interrupted while sharing with the medical team, but the individual may have trouble organizing the story in a meaningful way. How does the doctor let the patient know respectfully that what they are sharing is very important and that the team wants to hear that information, while also needing some other facts or additional discussion about a related topic? How they shift topics can definitely help or hinder relationship-building.
Look for ways the doctor shows respect during the physical examination in what they say and by their actions. Consider the way the physician frames the information for the patient so that they can understand. Finding out what the patient fears and exploring what they anticipate is critical before discussing a serious diagnosis.
Gentleness in answering questions and being patient with the individual’s concerns are critical for the physician to gain the patient’s trust. Can the patient also repeat back the instructions and express why those steps are important? Without this step, a doctor will not be able to determine if the patient truly understands.
It is impossible to tell you how often this is forgotten, only to have the patient return the next visit with no progress. As the doctor reviews and repeats back correctly what the patient has said and then lays the groundwork for the next steps, you have demonstrated the connection. All of this reassures the patient, who sees that the doctor cares.
When you head out for interviews or second visits to med schools as an applicant, be sure to ask students there how the patient-doctor relationship is taught. What do they observe the physicians do in the hospital or the clinic? Can they tell you about some of the better observations they recall on expressions of patient respect and demonstrations of trust by patients?
If the students are enthusiastic about this, that is a plus for the school.