Further, we are constantly under time constraints or being interrupted about the plethora of other issues surrounding our practices. I, for example, am currently developing both a heart failure program and chest pain pathway.
As a result, I will often get interrupted while with my patients to provide guidance to other clinicians or nurses facing complicated patients presenting with worsening heart failure or chest pain. When I do have to step away or take a call, I always try to make the time up to my patient, and I always show appreciation for their time by apologizing for the interruption. Although this may seem trivial, it is often not done, which as a result, leaves patients with negative impressions of their physicians.
By far the most important aspect of a good physician-patient relationship is communication.4 Whenever possible, I try to talk to my patients as I would a family member or a friend. When I need to make a point, I do not shy away from using personal and/or anecdotal experiences to help drive it home, and rarely do I avoid using humor when appropriate. Given the nature of cardiology, patients often walk into my office very seriously and worried. A little humor can go a long way in helping them feel more relaxed and ready to share their concerns or partake in therapeutic plans.
The second most important feature of a good relationship involves how we make decisions. I often share with my patients the research and guidelines from which I am basing my therapeutic recommendations. I always try my best to make it more understandable, despite variable levels of education, and whenever possible, I draw them diagrams or search for illustrations to help solidify the point.
However, even when they do not understand what I’m explaining, I have found that the mere fact that I took the time to try to explain it to them enhances the trust and confidence they have in me. Further, disclosing what we physicians do not know is equally as important. Physicians notoriously have a hard time admitting that they do not know the answer to a problem, yet much of what we do comes from incomplete research, consensus statements, and pattern recognition from prior experiences.
The truth is, we really do not always have a well-established, evidence-based solution to the problem we are trying to solve. For example, diastolic heart failure remains one of the most difficult and poorly understood conditions to treat. Nearly every clinical trial exploring potential interventions has been negative. Thus, when I discuss medical therapy with my patients, I tell them upfront, “these are the best options we have based on what we do know,” and that they may not work. I discuss the risks, benefits, and alternatives, and I share the decision making with them.
I avoid dumping the final decision on them; rather, I guide them by listening to their concerns, sharing my concerns, and negotiating a plan aimed at improving their well-being. I rarely offer any guarantees, but I offer support, guidance, and an unrelenting promise to work with them until we find a solution that works. That builds both trust and respect, especially when therapeutic interventions fail and alternative therapies need to be proposed. Without the valuable and instrumental trust that develops in a healthy physician-patient relationship, patients may seek care elsewhere or, worse, give up on their own care and suffer poor outcomes.