Bonding with patients when time is scarce

March 7, 2008

Even the busiest physician can find time to convey caring and concern.

It's a familiar formula: Increased pressure to boost productivity plus declining reimbursements equals less time with patients. That simple equation can wreak havoc on your ability to forge and maintain a strong doctor-patient relationship-an alliance many physicians have difficulty developing in today's medical climate.

Fortunately, in medicine (as in mothering), quality time really can compensate for quantity. As a clinical psychologist who has presented programs on relationship-building strategies for 25 years, I offer these suggestions to help you improve the quality of your interactions with patients, even when you're time-crunched.

Make the most of "face time." Greet each patient with a friendly handshake, which, in a recent survey, is what about 78 percent of patients said they most prefer when meeting a physician for the first time. Thereafter, give the patient your undivided attention. Avoid interruptions, whether from an intrusive phone call or a knock on the door, and don't multitask-no reviewing charts or sneaking a peek at a text message when you're with a patient.

A patient whose anger or anxiety goes unacknowledged may show hostility in other ways, possibly by breaking appointments, failing to pay, or not complying with treatment.

How to respond? Ask a patient who has a stressed or worried look if all her questions have been answered. Your question alone may be enough to quell her anxiety. Recognize that someone who complains about the crowd in your waiting room may really be expressing the fear that you're too busy to care for him. To ease his mind, emphasize that every one of your patients is special and gets as much time as is required, without exception.

Work together. Collaborate with your pa-tient-don't dictate. Ask for her impression of a proposed treatment plan, for example, and what questions or concerns she has about it. Rather than simply ordering a patient to follow a strict new drug regimen, head off problems by discussing situations where slip-ups are likely, and brainstorm steps to avoid them. If you're treating someone with chronic pain who's seen several physicians without getting help, talk about her experiences. Explain that reviewing these failed attempts will help you both avoid repeating them.

Shape behavior. If between-visit phone calls are a frequent problem, schedule a particular time for telephone consultations. Allow each patient up to five minutes to address "urgent" concerns. Frequently, you'll find that a much shorter exchange will provide the reassurance or resolution your patient is seeking. E-mail interactions could serve a similar purpose, provided you first address the legal concerns, privacy considerations, and other issues associated with electronic communications.

Empower patients. Providing patient education material, whether in the form of handouts or referrals to appropriate websites, can also lessen the number of follow-up phone calls. More importantly, having a trusted source of information helps patients feel more in control of, and take more responsibility for, their health. You can also hand out and briefly review educational material at the end of a visit or send it-by mail or electronically-prior to the visit. Either way, bolster the chance that patients will read it by asking follow-up questions: Is the information on target? Does it make sense?

In fact, never end a visit without asking whether the patient has additional questions, or other issues that should be addressed at the next visit. It may seem like extra work, but the time you take now is bound to save you as much-or more-later on.