January 27, 2016

Medical “Marriage” – Improving the Clinician-Patient Relationship

By Crystal Mendoza

By: Thomas Mork

“What do you know about him?” inquired my clinical instructor. I was on my first rotation as a student at the University of Utah and, using only two hands, was still able to count the number of patients I had seen. I commenced listing my patient’s home environment, his physical capabilities, etc. My clinical instructor cut me off. “That’s great, Tom, but what do you know about him?” I pondered the question for a moment.

“Well, he was a high school teacher.” I replied, questioningly. My clinical instructor smiled. “That’s it”, he said. And he made my goal for the next four weeks to learn something about the lives of my patients.

By the end of my clinical experience, I had formed a bond with my patients and their families that could be described as more than just a therapeutic alliance. Patients who had arrived in wheelchairs gave me hugs as they walked out the door. Families thanked me for listening to their needs and truly caring about their significant other or son or daughter. Seeing the ways we had affected their lives actually brought tears to my eyes on a couple occasions (not something I usually admit). My understanding of providing care has shifted from treating the disease to treating the person. I gained more from patients after understanding something about their lives than I did from focusing solely on the disease. Further, I gained greater satisfaction with my time as a student. I enjoyed going to work every day. This was a novel concept for me, and it was made possible because of the relationships I had formed.

“You can make more friends in two months by becoming interested in other people than you can in two years by trying to get other people interested in you.” – Dale Carnegie

In his book, How to win friends and influence people, Dale Carnegie said it right. As soon as I took my clinical instructor’s advice of learning about my patient’s, I instantly started receiving more positive feedback and had patients that were willing to work in therapy twice a day. Today, as I am in my third clinical experience, I still continue to work on learning about the lives of my patients to show that I care. I have found that taking the extra few minutes to ask about their family or hobbies can make the difference between whether they will work with me or decline therapy.

I had the amazing opportunity of taking a motivational interviewing class in December of 2015. The instructor was excellent at keeping us involved in the lecture by having us practice motivational interviewing. At the beginning of his talk, he tried to instill a spirit of “active listening” in us. Through practice and demonstration, the participants in this class reported that having a conversation with a person who asked probing questions augmented with personal stories was more enjoyable than talking to someone who did not say anything. While this is common sense, the process of taking a medical history mostly consists of a list of questions formulated to obtain the information we need to make decisions. If we do not augment these questions with a genuine interest in people’s lives, our patients will most likely find the conversation less pleasant and may be less likely to want to participate in therapy or healthcare. Thus, by becoming genuinely interested in people’s lives, we can encourage participation, make friends, and increase our own personal job satisfaction.

I was taught this as a student. There are multiple classes that tell you how creating a “therapeutic alliance” is beneficial to encourage participation in your patients, to improve outcomes, and to prevent lawsuits. I listened to my professors tell us this while thinking, “I am already good at talking to people.” Then, I returned my focus to things like the renin-angiotensin system to prepare for my next test. However, during the first few weeks of my clinical, I realized just how difficult it was to make my examination feel less like a list of questions and more like meeting a new friend. Creating a personal connection with someone you just met is a skill that requires practice and guidance. Developing this ability is something I have practiced continually since my clinical instructor’s advice. Now, if my patient had an accident while skiing, I ask them what hills they like. If a patient has shoulder pain while biking, I ask what trails they ride. I have vastly improved on my ability to make these personal connections. However, I wish I had learned more about it in school.

The ability to form a therapeutic alliance is an abstract science; it is a skill we cannot easily quantify with metrics or tests. Yet, I believe it is one of the most important skills that we can possess in the healthcare profession. The ability to create a bond with patients is something that comes naturally for some, but not all. The same goes for physics or anatomy. The problem is, while we have a multitude of classes for the latter, very little formal time is spent on the former; one could argue that creating a personal connection is just as, or more, important in healthcare and in life.

Thomas Mork - Photo Credit to Ryan Ledebuhr

Thomas Mork - Photo Credit to Ryan Ledebuhr

Our duty as a profession is to care for the person behind the patient. We can do this by becoming genuinely interested in the lives of our patients and tailoring our care to their needs. It takes the additional probing question and/or personal story to show that we care. Creating a therapeutic alliance is a skill that takes time to develop. It is something we can all return to when we find our history taking is looking more like a list of questions than a conversation. Hopefully, by forging these therapeutic alliances, the people we are helping will be friends rather than patients.

Thomas Mork was born and raised in North Branch, MN. He graduated from St. Olaf College with a BA in Biology and is currently in the third and final year of the Doctor of Physical Therapy program in the Mayo School of Health Sciences. He also currently serves as the Physical Therapy Student Assembly Vice-President

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Great article Tom! Thanks for sharing. I really like your point about students being more concerned about renin-angiotensin (or whatever rigorous scientific topic) and less concerned about learning to connect well or communicate well. It seems like changing that attitude may benefit many scientists and clinicians.

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