The New Doctor-Patient Relationship

Elyas Bakhtiari, for HealthLeaders Media, August 7, 2008

Physicians have a lot to deal with in today's increasingly complicated and bureaucratic healthcare system—reimbursement cuts, new technologies, quality measures, insurance contracts, compliance, pay for performance. Unfortunately, that sometimes leaves little time to focus on the most important piece of the puzzle: the patient.

Patients are getting overlooked all too often, according to an article in last week's New York Times that proclaimed the "once-revered doctor-patient relationship is on the rocks."

Many Americans simply no longer trust their doctors. Studies suggest one in four think their physicians expose them to unnecessary risk, and anecdotally many patients feel unheard and bitter.

Part of the blame lies, as usual, with the larger healthcare environment. Reimbursement cuts, doctor shortages, and rising costs make it hard for physicians to run a financially successful practice. So many cram in more patient visits and turn their practices into medical assembly lines.

At the same time, consumerism is taking hold in the patient population, and Americans are raising their expectations about medical care. Patients enter doctors' offices better informed and with more options for care than in the past. As the two trends converge, the relationship suffers.

But shouldn't physicians take some personal responsibility for the damaged relationship?

I certainly can't begrudge physicians for dedicating time to some of the more daunting challenges of running a practice. But declining reimbursement isn't necessarily a good excuse for a poor bedside manner.

Surely there's more physicians can do within the constraints of the system to make patients happy.

That's something I've considered a lot in the last few months as I've been editing the latest book in our Physician Entrepreneurs series about the quality patient experience. I sent the book's author, Wendy Leebov, EdD, the New York Times piece because she deals with this topic every day (she literally wrote the book on the subject) and I was curious what she thought.

The problem, she says, boils down to one issue: Communication. It's not that doctors don't care about patients anymore; it's just that they often don't have the time (or sometimes the skills) to get their messages across.

"Communication skills are really more critical than ever," she says. "With all the access people have to information and different perspectives, they don't want the doctor to just tell them what they need. They want to be engaged. When physicians try to get on with it because they have very little time, patients perceive this as physician not wanting their engagement."

Learning those communication skills can be as worthwhile as business management training or other leadership development because ultimately, the broken relationship is a bigger detriment to physicians than to patients.

Patient satisfaction is crucial to practice success, and its influence is only going to grow. Poor communication skills can hurt payer rankings, patient volume, and even quality—patients are less likely to adhere to medication plans and treatment options when dissatisfied with their doctor.

It's easy enough to blame the healthcare system and rationalize how the doctor-patient relationship broke in the first place. But no matter who broke it, the burden to repair the relationship lies squarely on physicians' shoulders.

Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at
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