This blog post was written by Dr. Nathan Moore, a SteadyMD team member and the author The Health Care Handbook: A Clear and Concise Guide to the United States Health Care System. Dr. Moore is a graduate of the MD program at the Washington University School of Medicine in St. Louis, Missouri and is a practicing physician.

Seems Like A Silly Question, Right?

No one ever asks if you get along with the cashier at the grocery store or the barista at your neighborhood coffee shop.  For most folks choosing a doctor means finding someone in your area who’s taking new patients with your insurance, which sometimes can only leave you with a few options.

Simply getting an appointment is hard enough. To also expect both a pleasant experience and a good relationship with your doctor can seem almost unreasonable!  In these days of electronic medical records and 15 minute appointments; many physicians simply don’t have the time to get to know their patients and find out their motivations, goals and fears.

A Better Patient-Physician Relationship Equals Better Outcomes

Decades of research have shown that a good relationship with your physician is important to your health.  Patients who have good relationships and effective communication with their physicians are more satisfied with their care and better able to manage their medical problems. They are also more likely to share information about their conditions which leads to an accurate diagnosis.  Furthermore, better relationships lead to patients that are more likely to take their medications and follow physicians’ advice.

Various studies have even found that productive patient-physician communication is associated with lower blood pressure in patients with hypertension, less patient anxiety in patients with generalized anxiety disorder, and less organ damage among patients with systemic lupus erythematosus. There’s also evidence that patient-centered communication can lead to reduced spending on tests.  Effective communication leads to more satisfied physicians as well, and fewer malpractice claims by patients.

Many factors contribute to the patient-physician relationship, including patients’ trust in physicians, active patient participation, patient involvement in decision-making, and providing adequate time for patients to ask questions. Physician communication skills are paramount, especially empathy, clear explanations, active listening, and respect for the patient. An expert panel concluded that physicians should include the following seven elements in all patient visits:

  1. Build the doctor-patient relationship
  2. Open the discussion
  3. Gather information
  4. Understand the patient’s perspective
  5. Share information
  6. Reach agreement on problems and plans
  7. Provide closure

Factors related to the health care system can also impact the patient physician relationship. These factors include the continuity of care (seeing the same physician multiple times), the patients’ choice of physician, accessibility of physicians, and providing sufficient encounter time. Encouragingly, formal training programs for practicing physicians have been shown to improve the quality of communication with patients.

It’s Clear What Should Be Done, But Most Physicians Aren’t Doing It

Unfortunately most medical care in the US doesn’t measure up.  Most primary care visits do not include the seven elements mentioned previously.  On average, physicians interrupt their patients within 30 seconds of the patient beginning to state the reason for their visit.  Most patients do not complete their statements after being interrupted.

Doctors tend to overestimate their communication skills. For example, the American Academy of Orthopedic Surgeons surveyed more than 1500 patients and physicians about communication.  75% of the orthopedic surgeons believed that they communicated satisfactorily with their patients, but only 21% of the patients reported satisfactory communication with their physicians.

So Why Isn’t Effective Patient-Physician Communication Happening?

Unfortunately, physicians have limited formal communications training in medical school. Much of what we learn comes from observing older physicians, who aren’t always the best role models.  After medical school most physicians receive no training or feedback about the way they communicate with patients.

The structure of our current health care system also adds to the problem. Health organizations and physicians are financially rewarded for seeing as many patients as quickly as possible, which is not conducive to appointments of the appropriate length.  Patients often can’t get in to see their physician when needed, so they head to urgent care or the ER where they meet a new doctor who doesn’t know them or their medical history. Health insurance plans change often, forcing patients switch to a different physician. This leads to poor continuity of care.

So What Can You Do To Improve Communication With Your Physician?

  • When meeting a doctor in-person, prepare, be organized, and prioritize: You may only have a few minutes with your doctor, so bring a list of your concerns and discuss them in order of importance.  If you don’t have time to get to everything, ask to book another appointment in a week or two.
  • Tell the truth: Most patients tell physicians what they want to hear. (“Yep, I take that cholesterol pill every day doc”).  This may make the appointment go smoother, but not being honest can lead to inaccurate diagnoses and poor care. Physicians can serve you better if you tell them about the side effects you’re having from your medications, about your concerns over the costs of the tests they just ordered, or how you actually got that nasty rash.  Remember, the doctors are there for your benefit so give them the full story and the best chance to provide excellent care.
  • Ask questions: If your physician recommends a treatment or test that you don’t understand, ask them as many questions as it takes until you have enough information to make an informed decision. Many people feel uncomfortable challenging physicians, but it’s the patient-physician team that determines the quality of care that’s provided.  If you and your teammate aren’t on the same page, then care will suffer.
  • If you’re unsatisfied with your physician’s communication, tell them. Waiting for the doctor to bring it up won’t work, because the physician probably thinks they’re doing a great job communicating.  Try to be as specific as possible with your concerns and how the physician can address them.  If that doesn’t work, ask to speak to the clinic manager or the patient experience supervisor.
  • Don’t be afraid to break up with your doctor: Not all relationships can be saved – sometimes you just have to move on. There’s plenty of doctor-fish in the sea.

Many resources are available for patients on this topic, including this useful guide from Consumer Reports.

Consider a Dedicated Online Doctor Through SteadyMD

Online primary care doctors available through SteadyMD have a few advantages over traditional doctors that allow them to create better relationships with their patients. Because SteadyMD does not charge per appointment, doctors are not under any financial pressure to see as many patients in a day as they can. On top of that, each doctor serves a limited number of patients. This means that each SteadyMD doctor is able to devote much more time to each individual patient and appointment. Their focus is on really getting to know their patients, and giving them the personalized care they need.

All SteadyMD doctors also offer same-day phone and video chat appointments, and patients can text their doctors at any time. This enables patients to much more easily (and regularly) communicate with their SteadyMD doctor.