As a medical student, I was standing in the corner of a patient's room while they were talking to the medical team about the upcoming decisions that had to be made. I noticed that one member of the team, the internist, had a strong emotional bond with the patient. I could see it in the patient's face. She felt relieved just by seeing the physician's face and talking to him. I noticed her change in emotions turning happy the second she saw him. That's when I thought: If she can change so drastically, maybe she'll need fewer pain medications after she sees him.
That specific situation got me thinking about all of the attending physicians I had on my clerkships. I realized that some of them had deeper, more emotional bonds with the patients than others and that this changed the patient's perception and understanding of his or her own disease.
Sometimes patients do not want to discuss specifics, like treatments, potential side effects, survival rates, or other statistics—they just want to talk to the person who is taking care of them and know that their doctor truly cares about what happens to them. I think that deep in their subconscious, patients want to feel that human-to-human contact and not just receive medical support and have some stranger talk to them about what the plan is for their upcoming hospitalization.
I believe that it does not matter if the patient has a minor infection or a terminal disease; sometimes they just want to talk to their doctor about their life and what they are feeling at the moment so they can better understand their disease and their future.
When a physician truly listens and shows that he or she cares, this means the world to the patient.
A strong patient-physician relationship provides comfort—a placebo-like effect that makes our patients feel better. Those daily 20-30 minutes that each physician spends in a patient's room can change their mood for the entire day, week, or months to come.
Because an emotional bond cannot be measured, it cannot be scientifically proven that a strong relationship could potentially translate into better overall survival rates or other statistically significant measurements. But it is logical that the patient's overall comfort will be improved, and this could result in fewer hospitalization days, better follow-up, and maybe even smaller doses of pain medications.
I encourage every medical student, physician, nurse, patient, and even family member to build a strong patient-physician relationship by talking to their doctor and asking questions. Because this, from my standpoint and my experience, does make a difference in the patient's disease course and overall in their life.
I am a medical student from a developing country who was fortunate enough to be able to do some clerkships in the US. One of my best opportunities was being able to compare the U.S. health system to the Colombian one. Because of the health system back home, we are not able to obtain a lot of images like CT scans or ultrasounds, so we have to rely on the history and the physical examination for clues to the diagnosis. So we spend more time with the patients and getting to know them, and I think this brings us closer to the patients.
Who is this person? It is not enough to ask just what they do for a living but to go deeper—to ask for how long have they been doing it, are they comfortable, and so forth. Such questions are basic ones that can make the patient feel closer to the physician and builds a stronger relationship between the two.
The message I want to share is that a good doctor-patient relationship does make a big difference in the patient's outcomes as I saw in all of my clerkships, including the ones I did back home in Colombia and especially the ones I did in the United States.
Daniel Rosas Saldarriaga
Institute De Cien De La Salud, Fac De Med, Medellin, Colombia
Back to the October 2018 issue of ACP IMpact