The Doctor-Patient Relationship: Responding to the Pressure for Fast Answers

The Doctor-Patient Relationship: Responding to the Pressure for Fast Answers

by Helene W. Stein, PhD
November 2008 (updated)

Foreword by CEHL founder, Dr. Howard King

A very common complaint from doctors in regard to medical practice is "there just isn't time." In the following article, Helene Stein acknowledges those pressures. They are a fact of life in contemporary medicine. On the other hand, for physicians to be effective in how they deliver care and for them and their patients to feel gratified from medical visits , they need to find ways to combine the "science" of medicine with the "art."

The following article suggests some ideas to consider in the current practice environment. Most insurers will reimburse physicians who encourage patients (or parents) to return for a follow up visit in order to help resolve some of these issues.

Responding to Pressure for Fast Answers

When I was a psychology graduate student, there was a raging debate in the field about the nature of psychology. Was it a science or an art? I was reminded of this debate when I met with a client who recently had some significant medical problems. It seems the debate is relevant to the physician's work as well as the psychologist's.

In conversation after conversation, the client spoke of all the specialists he had encountered in his efforts to get his ongoing medical problems under control. As I listened to his reporting of these experiences, it became very clear that some of his physicians were highly skilled in navigating his problematic psychological history. These same doctors could also give him information and advice in a way that he could hear it and use it. Others, however, simply irritated him to the point that he could not use the information they had to offer, no matter how well intentioned they were. What was the difference? It was certainly not due what the doctors were saying, it was due to how the doctors were saying what they had to say. Some of the most successful physicians had to tell him information that was very painful to hear.

In all fairness, the time and financial constraints on physicians these days are enormous. It's a high stress job with even higher stakes. It is always important for doctors to be careful and “get it right” and the demands for patient contact are increasing.

However, “getting it right” with my client was not a factor of time or the amount of hand-holding. It seemed to have more to do with the art of "reading" him quickly and effectively.

In other words, the physicians who had worked well with my client seemed to have mastered the art of understanding the irrational, illogical, and non-scientific clues that influenced how he would respond in a given situation.

No one who is ill is at his or her finest moment. Illness, particularly serious illness, can be frightening and overwhelming. Some people tend to act more as they did when they were children; others behave stoically, masking the fear and distress they're feeling. Still others intellectualize the experience and use debate or anger as a way of coping.

The most effective physicians were those who were able to sort my client's childlike responses from his healthy adult responses, and not react to either stance with a defensive posture or with disrespect.

The other distinguishing feature of of those physicians who were successful was how comfortable they seemed to be with themselves. They weren't necessarily more outgoing or sociable. Some my client even described as shy and quiet. They were able to use their own personalities to connect with my client - in other words, to communicate in a way that expressed genuine connection.

No one has the right response all the time. No one connects successfully with every person he or she must encounter. However, when time is limited and you only gave have one or two shots to get your point across, you need to examine your own style. You need to figure out what about your own style works for you and what gets in your way:

  • If the patient is making you feel defensive or attacked, why is that? Take a moment to figure it out. Acknowledge that what you are saying may have a serious impact on the patient's life or is information that's very hard to digest. You may be accustomed to saying it, but the patient isn't necessarily accustomed to hear it.
  • Listen to the words you use to explain yourself. Are your words ones that anyone could follow, regardless of their medical sophistication or education level? If not, how can you say what you have to say clearly, no matter how complex it is? If you say it accurately to the patient in language that he or she can follow, you'll save yourself a lot of additional time explaining it all over again.

The art of communication is even more essential now as the science that you need to share with patients becomes more exact and precise. And the greater the pressure for fast answers and brief encounters, the greater the importance of connecting to individuals and using personal responses rather than intellectual responses.

It increases the likelihood of your medical practice being more effective and also increases the likelihood you'll feel greater satisfaction from the tough job you have.

Helene W. Stein is a licensed psychologist. She has a private practice in Newton and consults to businesses and other professional groups. A version of this article was first published in the Boston Globe on November 1, 2001.

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I would like to thank the following for their generous support, without whom this web site and training program would not exist: The Sidney R. Baer, Jr. Foundation, The Alden Trust, the Commonwealth of Massachusetts Department of Mental Health, Project INTERFACE (Newton Public Schools and the U.S. Department of Education), the Locke Educational Fund at Newton- Wellesley Hospital, Aetna Health Plan, the Kenneth B. Schwartz Center,  and the families of my medical practice. 

I hope you find this site useful and encourage any comments.

- Dr. Howard King, M.D.