When I think back to the original meaning of the word “doctor,” I believe we may have lost our way in the physician/patient interaction. The word “doctor” originates from a Latin word, meaning to teach. As a physician and educator, I can’t remember the last time I went to the doctor and was taught something. Prior to starting medical school, I spent 6 months in the hospital and rehab, rebuilding my body from a construction accident. This situation was very painful and debilitating, but it provided me with the patient’s perspective to illness. It is from this perspective that all physicians need to originate. By teaching, you not only strive to treat, but you strive for the best outcome.
Physicians are not always the best communicators, but this is not a prerequisite to being a good teacher. Good communication is the result of being a good teacher. The natural progression of a teacher is to first know the subject well. Next, you need to provide a connection between the subject at hand and a positive result, by example or a proven endpoint. After this, strive for your presentation to be smooth, clear, and constructed to enable a memory imprint. After several years of teaching, you should become a good teacher. It then follows that you will have become a good communicator.
In 2005, Tongue et al looked at communication skills involving orthopedic surgeons. The surgeons considered themselves good communicators 75% of the time, but their patients listed them at 21% for good communication. It appeared they had mastered only step one of being a good teacher, knowing the subject well. Their follow up by using an example or a positive end point was lacking, with little of the presentation smooth, clear, or constructed for a memory imprint. Most of us were not born a good teacher. Physicians need to know what good teaching is and they need to practice it.
From a patient’s point of view, communication flows like this: 1) patients prefer a personal relationship with a physician to increase their comfort zone 2) they insist that information is clear and can be remembered after getting home and 3) most patients want to be involved in a decision and understand the decision. The physician and the patient need to work together to get back to health or stay healthy. A physician needs to think like a patient. How do they feel about a disease, common concerns, side effects of treatment, family concerns, when to talk and when to listen (true for patient and physician). This is easier to do at the start of a physician/patient relationship than years into one.
When patients understand their disease and are part of a partnership with their physician, they are more apt to carry out the plan.
Setting the stage for a successful physician/patient partnership has its complexities. The patient can be very nervous at the initial meeting. Patients are worried about taking up too much time, not having enough time, and forgetting valuable information they wanted to pass on to their physician. This is where the physician can provide the structure to put the patient at ease. This is done by defining the partnership as seen by the physician and by discussing together how these health issues can be understood and treated. This all goes back to solid knowledge of the subject matter, knowledge of common concerns, being open to questions, and awareness of the bumps on the road to recovery.
The good teacher/physician can develop a physician/patient relationship that can lead from sickness to health, together.
