It is well known by now that a physician’s demeanor influences the clinical response patients have to any prescribed treatment.
We also know that even when nothing is prescribed, a physician’s careful listening, examination, and reassurance about the normalcy of common symptoms and experiences can decrease patients’ suffering in the broadest sense of the word.
This has been the bread and butter of counselors for years. People will faithfully attend and pay for weeks, months, and even years of therapy visits just to have an attentive and active listener and to feel like they have an ally.
We also have data that shows that adherence to treatment plans is dependent on how patients feel about their provider. One problem solved can build an ally for life.
Primary care medicine is a relationship-based business. But often that basic fact is overlooked or denied.
Whether you are trying to get another person to alter their lifestyle, take expensive medicines according to inconvenient schedules, or even just trust and accept your diagnosis, you have to “earn” the right to do those things.
When looking for primary care, people still tend to ask, “who’s a good doctor.”
How do you, as a clinician in today’s restless and mobile society, earn trust and build therapeutic relationships in fifteen-minute visits?
Prepare yourself for beginning a clinical encounter. Your ABCs are Attention, Behavior, and Connection.
But where do you go from there, how do you continue, grow, and nurture a therapeutic relationship over time in the kind of environment most of us work within?
Here are a few lessons:
1. Listen and respond
How many times do you hear that patients don’t get to speak for even a minute before you interrupt them?
If you hear something that immediately requires clarification, do what you would do in a social situation.
Say that what the other person just said is important or interesting, reflect back what you think you understood and then be careful not to give them too many yes or no options, but invite them to continue their story.
2. Set an agenda
Patients may not reveal their real concern when making an appointment, and their priorities may have changed since then.
Going all-in with what you think is their main issue and saying, “do you have any other concerns” until the end of the visit is a recipe for disaster.
That agenda-setting may need to be addressed right away or after hearing a little about the main concern.
If you don’t ask what people need from you, how can you ever hope to fill your role as their provider?
3. Budget time
Don’t act frustrated about the reality that time is at a premium, and don’t declare that you have too little of it until you know how serious or urgent your patient’s concern is.
The person with a seemingly trivial concern may need you to help them with the biggest or worst problem of their life, so invest your time and attention on listening and understanding early on in the visit.
By acting unhurried at first, you are more likely to create an atmosphere of trust and caring; once you know your patient’s concern and their diagnosis or differential diagnosis, if they feel heard, you can move more quickly to wrap up the visit if you need to.
4. Don’t be a hero
If you try to be the hero in their stories, you create unhealthy, dependent relationships that often lead to patient disappointment or even resentment.
As guides instead of heroes, you also remind yourselves that you are not the ultimate experts on what is best for your patients.
Since your patients are the heroes of their own stories, they must ultimately decide which piece of advice from which guide they will choose to follow.
5. Balance disclosure
You can not build therapeutic relationships as only technicians;
You must engage as real people, and you can’t be real without showing emotion, genuine interest, engagement, and a good amount of humility.
6. Build continuity
From one visit to the next, find a thread to follow. For some patients, it is their chronic disease, for others, their family or their hobby.
Reconnecting about what you talked about last time is a powerful and quick way to reestablish the fact that you know each other and that you care about your patient.
It brings you straight into a space where you are ready to do the work you do.
7. Solicit participation
When it’s time to formulate a treatment plan, don’t be too quick to lay it out as if there is only one way to do things.
8. Plan when and how to reconnect
It’s important to agree on what to do after the test results come in, when the antibiotic runs out, if the rash doesn’t go away or when to meet up if everything is going well.
Not making such plans devalues the relationship and makes you look as if you don’t care about your patient.