While a physician’s clinical expertise is extremely important to patients, it is certainly not all that matters to them. The fundamental, and often-overlooked, aspect of a physician’s personality may be just as important to a patient as the physician’s clinical skills. The importance of a good bedside manner in helping physicians to avoid lawsuits should not be underestimated.

In fact, several recent studies suggest that quality of care and medical negligence are less important than a physician’s personal style and rapport with patients in maintaining satisfaction and avoiding malpractice suits. Adverse outcomes are less likely to motivate patients to sue if they are otherwise happy with the overall physician- patient relationship.

Forging Two-Way Communication
The historical model of the physicianpatient relationship, in which the doctor does the talking, is evolving toward a more team-oriented approach. Still, one study published in The Journal of the American Medical Association (December 1999) suggests that change doesn’t come easily or quickly.

The study, conducted by researchers at the University of Washington, tracked 1,057 office visits to 59 primary care physicians and 65 surgeons. Of the 3,552 clinical decisions made during those visits (from medication choices to follow-up appointments), the physicians engaged patients in fullfledged discussions—including questions about the patients’ personal preferences— only 9% of the time.

Clearly, many physicians need to improve their communication with patients. Physicians who shrug off patients’ questions and who fail to sit down, listen and offer thoughtful feedback are likely increasing the odds of problems later on. So how do physicians build and maintain constructive relationships with their patients? Specifically, how do they prevent their patients from the following:

• feeling as if they’re wasting their own or the physician’s valuable time
• feeling afraid or embarrassed to discuss certain things
• omitting details of their history that they consider insignificant
• feeling uncomfortable about asking for a simple explanation of medical terminology
• believing that their physician failed to listen—and, as a result, ignoring their physician’s advice.

There are several simple, yet effective, approaches for a physician to achieve open, honest and comfortable communication with a patient. Consider the following suggestions:

• Use your first name.
• Sit down with patients and maintain eye contact.
• Summarize appointments at the outset— for example, “First I’ll examine you, then we’ll discuss any problems or concerns you have, and then I’ll answer all of your questions.” This approach can help comfort anxious patients and calm their fears of the unknown.
• Ask questions about medical conditions and proposed treatment plans that require patients to respond with more than just a Yes or No—for example, “What do you think is causing these symptoms?” or “How do you feel about being on this medication?” This will encourage more meaningful dialogue.
• Listen without interrupting and remain silent while patients try to form the right words.
• Use nonverbal cues such as nodding to demonstrate attention and understanding.
• Acknowledge and help alleviate anxiety and other unpleasant feelings with reassuring words and actions—for example, “You seem worried; what’s wrong?”
• Laugh and use humor whenever appropriate. This helps express warmth and familiarity.
• Practice shared decision making to help improve compliance—for example, “Let’s discuss your treatment options and decide which one works best for you.”
• In addition to asking specific medical questions, inquire generally about the patient’s life—for example, “What’s going on at work?” or “How’s your family?” Besides demonstrating genuine care and concern, this may reveal additional factors that are affecting the patient’s health.

Most patients prefer a personal touch and would likely value the relationship even more if they knew something about their physician’s interests outside of the examination room. Of course it is up to the physician to decide whether or how much information to share, as long as the patient and his or her health concerns remain the focus.

Overcoming Time Constraints
For those physicians who feel as if they cannot possibly squeeze another second out of their busy schedules for more in-depth interaction with patients, there are timesaving solutions.

For example, a simple and increasingly popular tactic is to use educational materials such as pamphlets, videotapes or interactive CDROMs to communicate basic information about the risks and benefits of different treatment options faced routinely in office practice. The time saved on basic education can be spent discussing patients’ conditions, concerns, fears, hopes and preferences.

Conclusion
Physicians who make the personal connections most patients seek are increasing the odds for meaningful communication, healthy outcomes and overall patient satisfaction. No one likes to be rushed, ignored, talked down to or dismissed, especially when it comes to their health. Physicians who respect that fact will earn the lasting respect of their patients, thus minimizing the risk of malpractice suits.