My last post about placebo (or context) effects was one example of the innate healing capacity of our body-minds. During my 40 years practicing medicine, I learned that the quality of my relationships with patients had about as much to do with how well they did as the medicines and treatments that I gave them. That observation led me to research into how doctor-patient relationships can promote healing and how people make their journey of healing. This post and the next few posts will explore how healing happens. By healing, I don’t necessarily mean being cured, although that can happen too. The definition of healing that I found in my research was: healing means being cured when possible, reducing suffering when cure is not possible and finding meaning beyond the illness experience. If you would like to read the original research paper you can link to it here

This post will be about one of the characteristics of healing doctor-patient relationships that we call Valuing

Valuing

Valuing means very simply to see every patient as a person of worth. One of the patients put it this way in describing his physician: “Everybody who walks in front of her is the same.… She doesn’t care what kind of insurance you have, what color you are, how big you are, how small you are.”

When clinicians see every patient as a person of worth then certain characteristics of the relationship follow.

Finding ways to connect with patients

The doctors that I interviewed looked for ways to connect with patients, partly to help them care what happens to them. One of the doctors said ”I try to love every single patient. And I especially try to love those I initially hate. There has to be some reason why I want them to get better.”

Presence

People in my interviews talked about how important it was for their doctor to give them his/her full attention during their visit. Presence means not looking at his watch, not looking at the computer for most of the visit and not talking on the telephone during the visit. It means looking directly at the patient, paying careful attention to their story and not interrupting until the patient has finished telling their story of illness. As one patient reported, “…she is totally directed and focused on you when she is with you.… This is your time.”

Sufffering With

Another part of valuing is experiencing the patient’s suffering. This is not quite the same as empathy, but more like compassion. One physician described this as “dwelling for a moment in their pain, in their misery, not letting it float off our backs.”

Relativity of Time

When I talk about this research to audiences of doctors, their first response is ”I would love to do all those things, but time pressure is such that I have only 15 minutes for each patient encounter. There is no time to be present and connect with patients.” My response is that if you give your full attention to the patient in that 15 minutes, they will experience that as much longer. One of the doctors I interviewed felt that staying on time was very important, and most of his visits were about 15 minutes. This is what one of his patients said:  “Well he sat there and he listened. And he never rushed you out of the office. You took as long as you needed.”

One of the things I always did after I listened to the patient’s story was to ask the question ”Is there anything else you need to talk to me about today?” That question frequently led to the real reason for the visit. We might or might not have time to completely address all of the issues at that visit, but patients felt that they were heard, and that was important to them. I learned to ask that question because when I didn’t, often when my hand was on the doorknob to leave the exam room, the patient would say ”By the way doc..” and then I would hear the real reason for the visit after having spent the whole visit dealing with something else.

What to look for in your doctor

Hopefully many of you have a primary care doctor that values you in the ways I have described. Here are some red flags that suggest you might look for another doctor. 1. Your doctor interrupts you to ask questions after a few seconds. 2. Your doctor types on the computer for most of the visit and talks to you over her shoulder. 3. Your doctor stands while he talks to you and does not sit down. 4. Your doctor talks about himself for a good part of the visit. 4. Your doctor keeps looking at her watch.

Unfortunately all these things are much more common than they should be. There are doctors and nurse practitioners out there who truly value their patients as whole people and are present with them during visits. If you don’t have one like that, keep looking.

The next post will be about how doctors and patients manage power in relationships.