Physician-Patient Relations

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Within professional-patient relations, Physician-Patient Relations is defined as "the interactions between physician and patient."

A systematic review of the evidence followed with a winnowing by experts using Delphi found five key tactics are:

1. prepare with intention (take a moment to prepare and focus before greeting a patient);
2. listen intently and completely (sit down, lean forward, avoid interruptions);
3. agree on what matters most (find out what the patient cares about and incorporate these priorities into the visit agenda);
4. connect with the patient's story (consider life circumstances that influence the patient's health; acknowledge positive efforts; celebrate successes)
5. explore emotional cues (notice, name, and validate the patient's emotions)

Health communication

The perceived quality of health communication between provider and patient may influence the quality of healthcare including preventive health care and treatment.

The teach-back communication may improve communication. For example:

• "I've given you a lot of information. It would be helpful to me to hear your understanding about your clot and its treatment"

The medical interview

See also: Medical history taking

A qualitative study suggested benefit from the following 8 attributes of the health care provider:

• "do the little things"
• "take time"
• "be open and listen"
• "find something to like, to love"
• "remove barriers"
• "let the patient explain"
• "share authority"
• "be committed"

Being an empathetic listener and having a caring (as opposed to a dominant) attitude may help.

A supportive relationship that has "warmth, attention, and confidence" can reduce the pain of irritable bowel.

It is not clear whether the physician should wear traditional attire.

Before the interview

Various methods of helping the patient prepare questions prior to the interview have been studied without strong effect.

Greeting the patient

One study of videotaped physician-patient encounters concluded that "physicians should be encouraged to shake hands with patients but remain sensitive to nonverbal cues that might indicate whether patients are open to this behavior. Given the diversity of opinion regarding the use of names, coupled with national patient safety recommendations concerning patient identification, we suggest that physicians initially use patients' first and last names and introduce themselves using their own first and last names."

Collaborative agenda setting may reduce, "oh by the way," requests by patients at the end of the visit.

Hearing the patient's story

Although physicians frequently (3/4s of interviews) interrupt patients before the patient finishes listing their concerns. It is not clear that this interruption is bad. Not asking for the patient's concerns at all may lead to more concerns arising late in the interview.

After the patient finishing stating their chief concern, responding with "Is there something else you want to address in the visit today?" rather than "Is there anything else you want to address in the visit today?" may decrease patients' unmet concerns.

Engaging the patient

Encouraging the patient to participate in decisions may increase engagement and patient compliance. Using stories to describe medical evidence may help communication.

Patient activation can be measured with the "Patient Activation Measure".

Readiness to change can be measured by the Readiness to Change Ruler or by the University of Rhode Island Change Assessment (URICA) questionnaire based on the Transtheoretical Model of Change. The URICA is 23 or 32 items and a 12 item "'Readiness to change" version has been developed. The Ruler correlates with the full questionnaire and predicts behavioral intentions.

Health literacy

Health literacy can be assessed.

The length of the visit

There is not enough time during the typical doctor-patient visit to cover all concerns in spite of the increasing length of visits. Increased numbers of medical problems or concerns brought by the patient interfere with quality of care. Preventive care alone, if coordinated by the doctor rather than delegated, requires more time than available.

Longer visits are associated with higher quality and satisfactory care. Time restriction reduce satisfaction of physicians.

There is much variety in length of visits. Patient visits should probably be at least 20 minutes.

Facilitating recall of information

Patients (and health care professionals as well)have difficulty in recall details of the discussion during the visit.

The role of the computer during the interview

The presence of a computer and the electronic health record alters the dynamics of the interview.

Most patients do not mind the physician seeking online information and not appearing to be "all knowing".

Oh, by the way

The "by-the-way” syndrome is the raising of a new problem by the patient at the end of the interview. Starting the interview with careful eliciting of the patient's agenda may avoid this problem. However, when "by-the-way" occurs, the nature of the problem is usually psychosocial whereas the physician usually reponds with a biomedical reply.