Photo Credit: Ratana21
Communicating with patients with respect, curiosity, focused listening, mutual participation, and self-awareness improves patient-physician relationships.
Physicians who excel at establishing rapport with their patients and promoting patient-physician collaboration and improved outcomes share several key attributes, according to an interview-based study of internal medicine physicians who were recognized by their leadership and peers as having exceptional interpersonal skills with patients.
To investigate what behaviors and communication techniques help clinicians build rapport with their patients, researchers interviewed ten exemplary primary care physicians of various racial and ethnic backgrounds who practiced in an academic medical center, a Veterans Affairs clinic, and a safety-net community clinic. Questions during the thirty minutes involved strategies they used to connect with their patients while setting boundaries to protect themselves psychologically and stay on schedule. The authors then de-identified the interview transcripts and coded them to examine core themes.
Five themes emerged from the interviews: their respect for patients, engaged curiosity, focused listening, mutual participation, and self-awareness (Figure). Underlying these themes was a quality of authenticity, which the authors describe in the Journal of Primary Care & Community Health as “for instance, not simply acting and speaking respectfully, but internally experiencing respect for the patient’s experience, decision, etc. regardless of whether one agrees.”
Physician’s Weekly (PW) spoke with study authors Rachel Schwartz, PhD, and Sheryl Fuehrer, MD, about the importance of authentic patient interactions.
PW: For clinicians, what are your study’s most important findings?
Dr. Schwartz: We distilled a set of tenets that can guide authentic clinical interactions. Communication is the medium through which care is delivered in primary care encounters, and opportunities to improve the bidirectional, relational aspects of this interaction can potentially improve patient care and the physician experience.
Dr. Fuehrer: While most of the techniques that arose in our study have been reported elsewhere, the novelty of our finding was in considering authenticity in our interactions with patients. Many elements of care delivery are becoming increasingly circumscribed by the business aspects of medicine, with interactions resembling a customer service model. However, many topics we address in medicine are inappropriate for this model.
Why was it important to do this study?
Dr. Fuehrer: In non-acute settings, the physician-patient relationship is unique. Especially as we move toward a relationship-centered, shared-decision model of care, we must identify communication skills that ensure patient satisfaction while allowing physicians to do their job effectively. Focusing on communication strategies that support authentic connection and rapport in the patient-physician relationship provides an opportunity to establish a clinical environment where patients and physicians feel honored, heard, and respected.
Dr. Schwartz: We hope the communication tenets identified in this study will provide physicians with new relational tools to improve patient care.
What are some limitations of the study?
Dr. Fuehrer: The primary care setting may limit the generalizability of our findings to other specialties, such as emergency medicine, where physicians work under different environmental constraints and have episodic, not longitudinal, relationships with patients. Also, it’s hard to define authenticity. There is a fine line between authenticity, blunt honesty, and disrespect that needs to be sensitively navigated.
What unanswered questions do you have?
Dr. Fuehrer: More work is needed to break down the concept of authenticity and identify how to apply it to our patient interactions. Understanding how authenticity in the patient-physician interaction impacts physicians’ job satisfaction is important.
Dr. Schwartz: One interesting topic in this study, which has strikingly little research behind it, is how physicians could use self-disclosure to find common ground with patients. It would be valuable to know what the guidelines should be for that and other best practices around physician self-disclosure.
What additional comments do you have for clinicians?
Dr. Schwartz: The emotional labor inherent in care delivery is rarely discussed, and more opportunities for protecting physicians’ well-being while caring for others are needed. We hope the strategies we identified for fostering authentic and meaningful clinical relationships can be one step in that direction.
