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In Fostering Relationships, the Eyes Have It


Physicians who make frequent eye contact are more likely to receive high empathy ratings, and mobile technologies may be able to help providers in this aspect of care.

The results of a recent Northwestern University Feinberg School of Medicine study indicate that physicians who make frequent eye contact are more likely to receive high empathy ratings from patients. The study results, published in the Journal of Participatory Medicine, do not surprise Jon Handler, MD.

“Patients are in a very vulnerable and difficult time in their lives if they’re coming to see you,” says Handler, a board-certified emergency physician, and chief medical information officer of M*Modal, a leading provider of interactive clinical documentation technology. “You have to establish a rapport right away, establish a sense of trust. And eye contact is a really effective way to do that.”

Technology issue

Handler explains that technology has a major impact on the way physicians practice, both good and bad. For example, the Northwestern study focused on primary care physicians using paper charts so as to develop a baseline for measuring nonverbal communication activities. Information gleaned from patient questionnaires following their visits indicated that the amount of eye contact the doctor made was the most important factor for them.

“We have to realize that mobile technologies may be able to help us,” Handler says. “That whole dynamic changes when you’re using mobile technologies and you can put the thing in your lap or in your hands; you’re facing the patient while you’re doing the documentation.”

However, even tablets require physicians to look away from patients while documenting the visit; and that documentation is required to be reimbursed for providing care, as well as protecting against medical/legal issues, Handler points out.

“Speech recognition technologies, for example, may allow us to document more quickly, yet just as completely as we did before and not necessarily have to do all that documentation while we’re sitting there with the patient,” Handler says. “I think technology has been part of the problem, but technology can also be a significant part of the solution.”

Being genuine

There’s eye contact, and then there’s eye contact. In other words, says Handler, the eye contact physicians make with their patients needs to be genuine, unforced, not the type of penetrating stare that makes people feel uncomfortable.

“We don’t have to overdo things to fix the problem,” Handler explains. “We just have to get the clinician back to a position where he or she can be more efficient, with the help of technology. Where they can still multitask, but do so while facing the patient. And then just be normal. Just have eye contact like you would in any other conversation. Look the patient in the eye, and show empathy. That really means a lot to people.”

And while physicians are at it, Handler suggests they sit down as well. He says that studies have shown that patients perceive a visit to be shorter than it actually is if a physician enters the room and never sits down while speaking with them. Conversely, patients perceive that the physician spent more time with them, even if they didn’t, if the physician sat down during the interaction.

“These all seem like common sense in retrospect, and yet we see that the pressures of modern day care have led some of us to forget these things,” Handler says. “And then I think the care experience is better, more rewarding for the doctor and the patient.”

The bottom line translation

Handler believes that taking the time to improve the patient experience has several direct, positive effects on a medical practice’s financial standing.

Since patients, for the most part, are not experts in medicine, what criteria do they use to evaluate their physician? It usually involves answering these questions: Does the doctor seem professional? Does he seem like he cares? Does he spend time with the patient? Does he understand the patient and her problem?

“If the patients perceive you as empathetic, as caring, they will perceive you as a better doctor, and are more likely to refer you to their friends and colleagues,” Handler says. “And I think there’s a large amount of data that shows that the medical legal risk is reduced when you have a trusting relationship with your patients, which also affects the bottom line.”

In addition, notes Handler, when many hospitals in large provider institutions make their contracts with third party payers, the metrics of patient satisfaction are often a big part of the kind of deal physicians can negotiate with the payer. Simply put, physicians can negotiate a much more favorable deal if their overall patient satisfaction is higher.

“So, I think in many, many ways both indirect and direct, your bottom line is impacted in a very positive way if you have a really positive relationship with your patients.”

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