Sunday, November 24, 2013

The "Magic" of the Doctor-Patient Relationship



There is no doubt that in psychotherapy, some of what heals is the relationship the patient has with the therapist.  Medicines can be helpful, even when they are prescribed by a doctor with no personality, but no one enjoys going to see a doctor "just to get a prescription."  In therapy, it's hard, if not impossible, to heal if the patient does not see the therapist as being reasonably kind, empathic, and mutually valued, at least some of the time.   Aside from any medications, aside from the exact use of the words chosen, and aside from what tribe of psychotherapy the therapist aligns with, part of what heals is the relationship itself.  This we know.

But kindness, empathy, and interest are helpful in all doctor-patient relationships.
Psycritic has a charming post up called The Wizard: Psychopharmacology Magic.  Psycritic writes:

What most amazed me about The Wizard was his Zen-like serenity. Regardless of how much noise the patient was making or how many toys went flying around the room, he would be like the calm eye of the storm, holding still while everything else moved around him. His gaze was remarkable, intense yet warm and soft, like a bright candle. He would focus intently on whoever he was talking to, making that person feel important and special. His voice was smooth and soothing, almost soporific; perfect for those in emotional distress.
He took no notes during the appointments. His dictated progress notes were usually just a couple of paragraphs long, without pesky details like what medications the patient was taking and what medication changes were made during the visit. However, he did not have to remember those things. During the visit, he would shine his bright gaze upon the parents and say, "So tell me, what did we decide to do with the medications last time?" And the parents always provided the details. Maybe they knew that they would be quizzed this way, so they prepared so as to not be embarrassed. More likely, I think the parents were pleased that this eminent psychiatrist trusted them enough to empower them in this way.


Psycritic ends the discussion with: "However, I firmly believe that just being in his presence was one of the major therapeutic interventions that he provided for his patients and their parents."


It's not quite so lyrical, but over on KevinMD, Dr. Brian J. Secemsky, an internal medicine resident wise beyond his training,  also gives pointers on how to make your patients happy. He tells us:
1. Know your patients' names and interests and bring them up often.
2. Allow your patients to know something about you.
3. Communicate promptly, even if you have no answer.

Do those things, and in any field of medicine in our checklist era,  a doctor is  likely to be quite successful.

Let me add a few more pointers for good measure.   You can apply them to psychiatry/psychotherapy if you'd like, but they'll do for any field.

~Know the names of your patients' spouse, children, and pets, and ask about them.
~At the end of an initial evaluation, ask the patient how the appointment went for him/her.
~At the end of an initial psychiatric evaluation, or any medical appointment no matter how brief, leave a few moments to ask "What would you like to ask me?" (It's fine to admit you don't know the answer to a question).   
~Don't tell patients their problems are all in their heads.
~Don't tell patients in distress how others are worse off.  Patients already feel guilty for complaining or being unhappy.
~If a patient does not wish to follow your recommended course of treatment, explore the reasons why, respect them even if you don't agree, explain why you think it's important, and if the patient still does not consent, offer alternative forms of treatment. If there are none available, let the patient know that.
~Listen.
~Listen.
And finally:
~Listen.

What would you add to the list?