Doctor-patient communication: Patient perception

Abstract

Byline: G. Swaminath No Longer Patient While chatting with a popular and meticulous general practitioner about his referrals to psychiatrists, he remarked that he found his patients than satisfied with psychiatric consultations. This set me thinking of an experience I had had the previous day. That evening, I had two demanding patients - Ms. A and Ms. B - in successive sessions, of whom the second, Ms. B, on arrival informed me that the first patient, Ms. A, was complaining to her husband while leaving my consulting room of her dissatisfaction with the consultation. Later after I had finished with Ms. B, she remarked, Now I too am and promptly stomped out. Reflecting on what happened, I realized that I had seen two difficult categories of patients. Ms. A had been insisting that she did have a major physical disorder which had not been recognized in her previous consultations, was reluctant to consult a psychiatrist, denied any psychological stressors and complained that she did not believe that her illness could be due to psychological factors and that despite this was advised otherwise and prescribed sedatives. I too had felt unsatisfied with the consultation as she left on a sour note. Ms. B, on the other hand, did not believe she had a problem, insisted that her suffering was due to issues with her husband's family and was reluctant to take drugs for someone else's mistake. She was unhappy at being told that her fears and suspicions about her husband's family could be part of her belief system and that she would feel less animosity and more calm with drugs. She left suspecting me of conspiring with her husband's family against her. Both Ms. A and Ms. B have not since come back for consultation. Physician - Patient Communication At its worst, patient dissatisfaction could be fatal to the treating physician. The case of 50-year-old Dr. Vasant Waman Jaykar, a cardiologist of Mumbai, who was shot dead in January 2001 by a deceased patient's dissatisfied relative, brings home the point.[sup] [1] Thankfully, dissatisfaction very rarely takes this extreme form; nor does it cause patients to lean towards the other extreme, i.e., the Gandhian approach of showing the other cheek. The reaction is generally muted like in the case of A and B, who stopped at voicing their rejection of the physician. Such rejection may at times be more passive. All these responses may seriously harm the physician. Research has shown that the way patients perceive their connection with their physician significantly influences their sense of satisfaction and level of concern about their health.[sup] [2] In the fast-paced managed-care environment, relationship-building conversations can get lost in the pressure to perform. The demands of keeping abreast of the latest medical-treatment approaches can overshadow the need to practice and improve communication skills. A good effective, empathic physician-patient communication leads to improved patient compliance, better clinical outcomes and reduction in doctor-shopping and malpractice litigations.[sup] [3] Neuwirth[sup] [3] notes that good communication is good business practice. He further suggests that contrary to general assumptions, communication skills are not strictly inborn assets or talents but rather skills that can be learned and developed - much like those needed to learn to play a musical instrument. The musical instrument metaphor is particularly apt, as playing the instrument well requires continuous practice and improvement, regardless of the level of talent. The need to address physician-patient communication lies in the necessity to continuously improve and hone one's ability to communicate in ways that build and sustain positive patient relationships. The importance of patient's perceptions, physician empathy and communication style can never be overemphasized.[sup] [4] Patient Perceptions Matter Many of our patients complain that the duration of consultation was inadequate and that the consultation was hurried. …