Physician Roll Call: Maintaining Doctor-Patient Relationships

What's a doctor to a patient? An advisor? A confidant? A friend?

Cleveland Clinic physicians sat down with MD Magazine to share their perspectives on what makes for the best doctor-patient relationship.

Dr. Mark Bain, Neurosurgeon, Cleveland Clinic: I think it’s really communication-based. It’s an obvious statement, but it’s really true. A lot of the things we do are high risk and patients are very nervous to come to us with these horrible problems — strokes, aneurysms, they’re really freaked out about them. Good patient communication is vital. The other thing we try to do is we try to bring patients into the decision making, so we give them options. We say ‘we can do this way, we can’t do this, what works better for you and what fits better with you lifestyle?’ But communication is at the foundation of everything we do.

Dr. Betul Hatipoglu, Endocrinologist, Cleveland Clinic: I become a friend to my patients, which is not necessarily a thing every physician would like to be, or every patient would like to have with their physicians. But that’s my style. You need to get their full trust to you, that you indeed are thinking what’s going to be the best for them. So you have their back. That’s the most important thing in a patient-doctor relationship: trust, and the feeling they can tell you anything.

Michael Manos, PhD, Head of Center for Pediatric Behavioral Health, Cleveland Clinic Children’s Hospital: An essential quality of relationship — time spent with a parent at the beginning of a treatment — is quite important. In fact, studies have indicated that when a physician gives more attention at the beginning of initiating treatment, then adherence is far more consistent, and the effect of treatment is much more realized. In addition, I think it’s very useful for the physician to be able to know exactly what a parent is going through. And essentially, the physician can deliver the message that diagnosis is not destiny.

Dr. Rishi Singh, Ophthalmologist, Cleveland Clinic Cole Eye Institute: I think the most positive thing we can do to maintain a good doctor-patient relationship is have a healthy dose of understanding on both sides. Not every patient is the same; they have their unique circumstances. As a physician, sometimes if patients don’t show up for their appointments, many of us think that’s non-compliance and label it as such. In fact, people have really valid reasons not to come to their appointments sometimes. Sometimes they can’t see well enough to come to their appointments, sometimes they don’t have transportation to even get to their appointments because their vision is too bad, sometimes the other systemic conditions a patient might have might limit their ability to come see me. So, we both have 2-way streets and vice versa.

Dr. Carlos Romero-Marrero, Section Head of Hepatology, Cleveland Clinic: It’s very important to create expectations from the beginning. One of the challenges we have with the Hepatitis B and Hepatitis C medications is that, because of the cost of these medications, not all patients are going to be approved by their insurance companies to get treated. It’s very important that we set expectations, we talk to the patients and tell them ‘This is a chronic condition, this is the natural history of the disease, this is what could happen.’ So I think it’s very important we emphasize on the location, too. I think once the patient is empowered with the information that they need to know their disease, that’s going to help you on creating the treatment alliance you need to move things forward at the personal level.

Dr. Umesh Khot, Vice Chairman, Cardiovascular Medicine, Cleveland Clinic: There’s a lot of things going on in healthcare today which are taking the doctor away from the patient. We have a lot of burdens from other documentation, billing, these other things. But I think that when you walk into that patient’s room, that patient is the only thing that should matter at that point. And putting that patient at the center of the care process, particularly at that moment of time, I think is the foundation for making sure that the patient care is centered at that point.