After returning from a presentation by Dr. Rachel Naomi Remen, I was moved to write about the impact of the quality of the relationship we create with our patients.

In our time-pressured lives and clinical practices, we often begin to over-focus on “What is the matter with my patients” rather than “What matters to my patients”.

Research by Little et al reveals that patients want providers to:

  • seek an integrated understanding of the patients’ world—that is, their whole person, emotional needs, and life issues;
  • explore the patients’ main reason for the visit, concerns, and need for information; and
  • enhance the continuing relationship between the patient and the doctor.

The quality of our relationship with patients is often determined by our general state.  State is defined as the integrated sum of mental, physical and emotional conditions from which a person is acting. Our state significantly affects whether our patients actually leave medical appointments feeling better.

I have yet to meet a provider without at least one painful story of being ignored or feeling mistreated by a health provider when they felt vulnerable A quote from Anatole Broyard’s essay Doctor Talk to Me sums it up:

 

“To most physicians, my illness is a routine incident in their rounds, while for me it’s the crisis of my life. I would feel better if I had a doctor who at least perceived this incongruity.”

 

Here’s a contrasting story of what is possible. I was very distressed when my 80 year-old father was to undergo heart surgery in Ohio and I was miles away in Arizona. I quickly arranged for airline tickets and was on my way. As I was arriving at the hospital, my mother told me that despite the graveness of the situation, my father was in good hands. She began describing his surgeon who listened attentively and turned off his pager to answer my father’s detailed questions. My mother then relayed that the nurses on the cardiac unit told my father every day that they loved him.

I was astounded. I had to clarify if I heard her correctly. Yes, she assured me it was true. I was then flooded with a sense of relief and gratitude. My father was being seen as someone not to be “fixed”, but someone to love. My father’s providers clearly practiced and valued interacting from an open and caring state. My parents were reassured and confident that everyone would do their best.

I also sensed everything would be all right, whatever the outcome. My entire family was being held in their heart-felt care. (The surgery was successful and my father at 87 continues to plant amazing gardens that feed half the neighborhood!)

So we intuitively know that we prefer our providers to demonstrate caring. Moreover, Duncan et al concluded that an affective bond (along with agreement on goals and tasks) accounts for 60% of treatment affect. But how many of us identify a caring state as a personal strength or claim it as a clinical development objective? It is time to do so.

So here’s a way to experience positive states that improve the quality of relationships you have with your patients:

  • Take a moment to reflect on a specific time when you really connected well with a patient. How were you being and what did you do and that made it possible?
  • Write a few words down that represent this experience.

Now consciously practice this state at least once a day for the next week with your patients and notice what happens. Consider deepening your state by slowing down and reminding yourself regularly to come back to the present moment with your patient.

Your ability to recall this experience is an example of managing your state to improve effectiveness and outcomes.

Notes:

Dr. Remen’s New York Times bestselling book Kitchen TableWisdom: Stories That Heal is published in eleven languages and used in the curricula of medical schools across the country.

Little P, Everitt H, Williamson I, Warner G, Moore M, Gould C, et al. Preferences of patients for patient centered approach to consultation in primary care: observational study. BMJ. 2001;322:468–472.

Duncan, Hubble, & Miller The Heart & Soul of Change [APA, 1999]