Patient-Physician Relationship: Part two

Patient Satisfaction:

How important is the patient-physician relationship? Will a strong caring patient-physician relationship automatically promote patient satisfaction? Unless the answer is "of course," I think that each patient encounter redefines the terms of the relationship. Does the outcome always have to be excellent, even perfect? For each clinical condition, there are infinite variables when treating an individual's physical being, let alone their own traits and character. Satisfaction requires that each treatment plan include a definition of the expected outcome. The outcome expected by the patient is often significantly different from the physicians' initial or final goal of treatment. Long term outcomes are even more difficult to define when initiating treatment.

Has the monetary cost of an illness affected the patient-physician relationship? Is a $10 - 20 per month reduction in a family's monthly medical insurance bill sufficient to cause them to switch to a new doctor on a different insurance plan? How important is the actual cost of an illness to patient satisfaction? Do patients care about the cost of being cared for in the ICU when they are in distress and fearful of dying? Do they care, one month later at home, when the hospital bill comes after the insurance company pays their portion?

The patient-physician relationship is the key to success in caring for a patient. The patient must initiate the relationship with an honest, truthful, and completely open discussion of their condition with the physician. The physician should initiate a plan to diagnose and begin treatment using the best tools and treatment protocols in 1998. The physician's recommended treatment will be based on the initial history of the patient's illness. A poor and uncaring response from the physician is unacceptable from anyone's standpoint. The initial response from the physician will be critical in promoting further growth and development of the relationship. Yes, the first words spoken by the doctor may be the most remembered by the patient. You never get a second chance to make a good first impression. Communication channels have to be wide open. After the decision to treat the patient's specific or multi-factorial condition has been made two new concerns arise. Does the patient have an adequate understanding of their clinical condition? What are this patient's expectations of treatment? Based on these factors, a physician may alter the plan of action and the expected time line to completion of the care required for the patient. Through open conversations, including the truth that illness can evolve into a serious life threatening episode, the relationship between the patient and physician will be sustained. Together they will develop a valuable treatment plan.

If the patient is referred by another doctor known to the patient and trusted by the patient, then the first step is easy. If the patient chooses a physician because their name appeared in their insurance reference book, then the first moments may be clouded by a natural uncertainty on both sides. Do patients ask themselves on the way to the new physician's office, did I enroll in an expensive enough insurance policy to guarantee me a top of the class primary care physician or specialist? Do physicians ask themselves, what monetary value does society, let alone the individual patient place on their consultation and advice?

The next step revolves around two concept time management and patient education? Yes, each person's time is valuable. Waiting is never easy in a physician's waiting room! Rushing by the physician to get through is not always productive, and can be viewed by a patient as uncaring or even make the patient feel that the physician missed the diagnosis by not giving them enough individual attention? By taking their time and adequately understanding their patients' health problem, there will often be delays in the daily office schedule! Time also needs to be spent on patient education.

Educational issues arise immediately. Do I (patient) understand my disease or disorder enough to properly carry out the doctor's instructions? Do I (physician) inform my patients adequately to obtain an informed consent?

Watch. More and more patients' family members now enter the physician's office or hospital room with printouts of Internet web articles on the specific illness. I enjoy helping the family understand the disease by providing pamphlets and specialty specific web information. The physician still has to interpret the information for the patient and their family and relate the data to the current clinical condition of the patient. Yes, this takes time! And I have little left for my family. The satisfaction of having the knowledge of their disease state or condition cannot be over emphasized. Such anxiety is produced by going to the Doctor's office when you become sick. I want to know what is wrong with my loved one. I relax when I can focus on managing the treatment for a specific diagnosis.

In the Information Age I need to improve upon my abilities to educate my patients.

I asked the questions: Do I need Internet access in my office? Do I need a web page?

I want the family and patient to comprehend the issues surrounding their illness. Patients do not recall all the information presented to them after the initial office visit. After the visit, I want the patient to be able to quickly access specific data about their illness. They will be given pamphlets or instructions at this starting point in their education. I try to offer valuable information to my patients through my web site. I do not want my patient to lose time surfing the web for hours finding too variable and often nonspecific data. Information acquisition especially through the Internet is a growing trend in America. Also, Medical Encyclopedia CD's and software are included on many PC's sold today. Health related software can be purchased to search for general information of common Medical and Surgical diseases. Through education the patient satisfaction index should rise.

Institutions of higher learning are engaging in the active dissemination of information to healthcare providers. The physician can find research protocols or pharmaceutical drug data on the web. C.M.E. credits on Bioethics are required for renewal of a physician's license in the State of Texas. Bioethics in Managed Care are a new subject deserving of further discussion. Finding new alternatives or ideas on the Internet or through E-mail, including sending MRI images or photographs as graphic files to colleagues may aid the physician in identifying additional treatments for their patients. Result: Improved patient satisfaction.

If the patient is to be satisfied then their family isn't going to be thrown into debt. The family must survive in order to support and enhance the patient's outcome. Many family members want to help in any way. The effect of a love one's illness can be devastating on a family. Emotional support and open communication of the truth about their family members illness is the first step taken by a physician in the healing of the family. The unknown can be so anxiety producing for them. With many health care providers talking with the family and patient and using all available educational tools, the physician can quickly calm the "cerebral ventricular waters" of most family members. Patient satisfaction will include some degree of family care.

Should society be concerned about excessive attention placed on their physician's economic performance? Will the evolutionary effect of this focus on the business of the practice of the medicine bring about improved patient care and expected outcomes? Is this what the patient really wants? Do you want the physician that costs the least? Well, YES, if the physician was trained in a high-powered medical university and has acquired such experience and obvious excellent clinical skill and diagnostic ability that tests to rule out every known disease is not required. NO, especially if the ineffectiveness from trying too hard to reduce charges to the insurance carrier equates with a poor patient outcome and too many complications due to untimely diagnosis of an acute illness. Do I want a strong preventive medicine approach to my health? Are preventive care and routine physical exams covered by my insurance carrier? Will genetic testing and analysis of my chromosomes alter my lifestyle and affect personal health care treatment in the future? Where will the data be stored and who will have permission to access the data? More patient satisfaction issues arise.

I know only physicians who work too hard, too many hours and with such care and compassion, that words do not explain the obvious. Look into their eyes. You can see the toil of long and stressful hours of work. You should take on Medical School. Unexpectedly, private practice required more and continual intensive management of a patient's condition. The efforts of the physician and availability to interact with their physician in a timely manner still bring a sense of satisfaction to the patient. There are too few hours in the day to spend the needed extra time with the patient and discuss health issues not directly related to the current illness. An example would be talking about Health Care Directives related to end of life issues such as the Living Will or Durable Power of Medical Attorney. Satisfaction with the outcome of the current illness may be affected without a holistic view of the patient. Satisfaction may mean eye contact and exchange of smiles during not just at the end of a successful treatment plan. The course of the illness or treatment program will not always be smooth and an individual's recovery may differ from the normal expected outcome. Remember to thank your physician if you're satisfied!

For more information on Bioethics on the Internet, link to