Blog | Monday, May 20, 2019

Dear doctor, here's why your patient didn't like you


The era of the empowered patient and patient-centered health care has been upon us for some time. Only a generation ago, there was a much more paternalistic approach to medicine. This has changed for the better across the western world.

As somebody who teaches and coaches physicians on how to improve their communication skills, I would say that the newer generation of doctors is much more receptive than many of their older counterparts, in learning new skills in this area (which is a pleasure for me to say, because they are ironically also the generation who has come through a system where they have to spend an unacceptable amount of their day attached to a screen). As with any service-oriented arena, how you communicate often trumps competency, in how people perceive you. I'm not saying this is right, just that it's the way things are. While being a doctor certainly isn't a popularity contest, being able to establish rapport and being a good communicator, is a core component of being effective at what we do.

If you've been around for any length of time, you've probably heard a patient or two say something along the lines of: “I didn't like that doctor”, based on only one interaction. Here are three reasons why that may have happened:

1. The doctor was visibly in a hurry
This is a big no-no. Every doctor is probably in a hurry, because that's the nature of healthcare. We work in a suboptimal system with multiple demands placed on us. But that's not the patient's fault. There are certain verbal and non-verbal cues that give this away like a red light (I wrote about some of these here). Part of being a professional, is having your “game face” on at all times. For physicians, that means not showing very obviously you are hurried, and carrying a calm demeanor.

2. Brush things off
When patients come to a doctor with something on their mind, it's never trivial. For the doctor, who may want to focus on something else, there are subtle ways to redirect the conversation, but never in a way that appears to minimalize a concern or belittle a legitimate worry. Happens all too often I'm afraid.

3. Not caring
This is the absolute worst thing any doctor can ever come across as. Yet I hear patients complain all the time that their doctor came across like that (albeit a small minority of cases). No matter how long our days, hectic our to-do list, or difficult our patients— the onus is on the physician to display a caring and compassionate attitude. Certain techniques that help with this include active listening, eye contact and using open-ended questions.

Occasionally when I teach my courses, I get pushback from physicians along the familiar lines of: “Oh does this mean I just give my narcotic seeking patient what they want?!” or “We have such difficult and frustrating patients!” Another classic is: “Hospitals are not hotels!” Fair enough, but nobody is saying that hospitals should be like hotels. Those difficult interactions are also the minority of patients in most places. They should not be used as an excuse not to improve our communication skills, or to not have a level of self-awareness of one's own flaws. While no amount of teaching in the world can turn somebody who is a poor communicator, into an amazing one—each one of us can always go up a few rungs on the ladder, if we are motivated to do so.

Patients deserve the best performance from us during that brief allocated time slot we are given. Another statement I hear sometimes from doctors is: “Sorry, but I am not an actor”. Sorry, but you are already an actor! Every professional is. By using this word, we are not talking about being inauthentic or fake. On the contrary, anyone who is in a professional job or position of responsibility knows they have to put their “professional face” on—and deliver their best. Are you the same person you are at work as you are at home? Do you talk the same way to your patients as you do your family and friends? Do you take on a different persona when you don that white coat and step onto your stage? We know what the answer is. That's why we always want to master the art of appearing calm, listening to all concerns, and showing that we care—with every patient we see.

Suneel Dhand is an internal medicine physician, author and speaker. He is the founder of DocSpeak Communications and co-founder at DocsDox. He blogs at his self-titled site, where this post first appeared.