A recent article in the Wall Street Journal reported on doctors’ lack of communication skills and how that affects quality of care, healthcare costs and patient lawsuits. No surprise there. Doctors’ communication skills are a current hot topic. But I think we’re forgetting that a physician’s communication skills are only one piece of the puzzle. The doctor-patient relationship is the heart of good healthcare. That relationship includes communication, and it affects quality of care, patient satisfaction, treatment adherence, patient safety and more. (U.S. News&World Report) 

Physician communication skills have been part of the curriculum for medical students for years but a successful medical encounter isn’t just about a doctor conducting a good patient interview, taking a thorough history, or explaining medical information in a way that a patient understands.

It is also about the quality of the doctor-patient relationship.

The relationship between a physician and patient does involve successful communication from both parties, but let’s not forget that a personal connection or bond enhances trust on the part of the patient. A doctor can be a good communicator and the patient can still not trust her. That lack of trust impacts treatment adherence, patient satisfaction, patient safety, and a willingness to return to the doctor.

For trust to develop with a patient it involves more than the obvious; a doctor’s good credentials, experience, reputation and communication skills. A doctor has to be a good listener, and good listening involves the ability and willingness to focus on a patient’s story and tune out distractions and time pressures. Actively listening means not only replaying key elements of what the patient has shared but conveying empathy. For a patient to trust a doctor, she has to feel heard and cared for. According to Health Affairs, patients have to believe that doctors are acting in their best interests. 

I can tell you that during my 16-month chronic pain condition, it was the doctors I connected to personally who won my trust, whose advice I followed, and with whom I lived up to my end of the bargain as an engaged and empowered patient. I saw plenty of physicians who were good communicators but who left me out of the equation and therefore failed to incite my trust, my confidence in them, failed to enlist my commitment to their proposed treatment plans. It was the doctors who looked me in the eye, who treated me with respect and who collaborated with me in my care, who won my allegiance.

The importance of looking a patient in the eye can be overlooked by many doctors who are tied to their iPads and laptops with the onset of EMR requirements, according to The British Journal of General PracticeGlancing up from the keyboard or computer screen and establishing eye contact with a patient can help facilitate an effective relationship and engagement with the patient. Eye contact implies respect and emotional connection.

Speaking of engagement, the relationship between patients and physicians can facilitate patients as partners in their care. Communications skills alone can’t do that. But a personal connection, in concert with successful communication and patient engagement, stands a much better chance.

A successful relationship between doctor and patient includes shared decision-making. Creating a working alliance with patients has many benefits. According to The New England Journal of Medicine,  shared decision-making includes the patient’s preferences, values, cultural orientation and beliefs. Doctors can include the patient by using a variety of decision aids such as written materials in the patient’s language, videos, visual models and even hand-written drawings. For shared decision-making to be successful the doctor must have good communication skills and create a personal connection with the patient. Not all doctors have the time or desire to do that.

Change takes time.

I welcome your comments.