The key to solving the doctor-patient relationship | Stephen Khachikian | TEDxRapidCity

Summary

The speaker discusses the evolving nature of the doctor-patient relationship, emphasizing that it's more than just medical care—it's about empathy and emotional connection. They argue that while time constraints and routine issues often reduce interactions to mere transactions, patients still seek meaningful relationships with their doctors. By sharing their emotions and vulnerabilities, patients can foster a stronger bond with their physicians, leading to better care, understanding, and outcomes. The talk underscores the importance of empathy and collaboration for improving both patient experiences and treatment results.

Takeaways

• 🤔 The term 'doctor-patient relationship' has evolved to focus more on confidentiality than on the actual relationship between doctor and patient.
• 🕰 Time constraints and busy schedules have contributed to the erosion of the traditional doctor-patient relationship, especially for routine issues.
• 👥 Despite the challenges, patients still desire and need a strong relationship with their doctors for better healthcare experiences and outcomes.
• 🗣️ Patients often express their desire for a relationship by asking how to pronounce the doctor's name, indicating a wish to know and be known by their healthcare provider.
• 👂 Listening to patients' concerns and fears is crucial for establishing a deeper doctor-patient relationship beyond just treating the ailment.
• 😟 Patients often feel vulnerable and apprehensive during medical consultations, which can hinder the formation of a strong doctor-patient relationship.
• 👨‍⚕️ Doctors can bridge the emotional gap by showing empathy and understanding the patient's personal situation and emotional state.
• 💡 Sharing personal fears and vulnerabilities with the doctor can help align the doctor's treatment goals with the patient's personal needs.
• 🌟 A positive outlook and strong doctor-patient relationship can lead to better healthcare outcomes and the ability to handle negative outcomes more effectively.
• 👥 The emotional connection between doctor and patient is beneficial not only for the patient but also for the doctor, as it provides a sense of purpose and fulfillment in their work.

Q & A

Why does the speaker dislike the phrase 'doctor-patient relationship'?

The speaker dislikes the phrase 'doctor-patient relationship' because its meaning has shifted over time, now relating more to confidentiality than to an actual, meaningful relationship between the doctor and patient.

How does the speaker describe the modern doctor-patient relationship?

The speaker describes the modern doctor-patient relationship as more transactional, where doctors have less time to build meaningful connections due to busy schedules, increased patient loads, and the complexity of medical systems.

What does the speaker believe patients want in their relationship with their doctor?

The speaker believes patients want a strong, caring relationship with their doctor. They desire to feel understood and for the doctor to show empathy toward their personal and emotional struggles.

How does the speaker know that patients value relationships with their doctors?

The speaker realizes this because one of the most common questions patients ask is, 'How do you say your name?' This shows that patients are interested in connecting with their doctors on a personal level, starting by knowing their names.

What is the difference between a doctor-patient relationship and a friendship, according to the speaker?

The speaker explains that a doctor-patient relationship differs from a friendship because, in a medical setting, patients may need to share personal information that they might not feel comfortable sharing with a friend, especially concerning their health and vulnerabilities.

What role does emotion play in the doctor-patient relationship?

Emotion plays a significant role in the doctor-patient relationship. When patients express their fears and vulnerabilities, it allows doctors to empathize and form a deeper connection, which helps in setting and achieving mutual goals for the patient’s well-being.

How does the speaker suggest patients improve their relationship with their doctor?

The speaker suggests that patients can improve their relationship with their doctor by openly sharing not only their physical symptoms but also their emotional concerns and fears. This helps build empathy and creates a partnership between the doctor and patient.

Why does the speaker emphasize the importance of the patient’s emotional state in medical care?

The speaker emphasizes the importance of the patient’s emotional state because it greatly affects the outcome of the treatment. Patients with a positive outlook tend to do better, and understanding their emotional fears allows the doctor to provide more personalized care.

What benefits does the speaker mention about having a strong doctor-patient relationship?

The speaker mentions that a strong doctor-patient relationship leads to better outcomes, helps patients handle negative outcomes better, and creates a shared goal between the doctor and patient, improving the overall experience.

How does the speaker propose patients handle their fear and uncertainty during medical treatment?

The speaker proposes that patients handle their fear and uncertainty by communicating their emotions and fears to their doctor. By doing so, they can build trust and feel more in control of their situation, which improves their overall medical experience.

Outlines

00:00

👨‍⚕️ The Evolving Doctor-Patient Relationship

The speaker expresses a dislike for the phrase 'doctor-patient relationship,' feeling it has evolved from its original intent. While once focused on personal connection, it now centers on confidentiality and is often rushed, especially for routine issues. Despite these changes, the speaker emphasizes that patients still value and seek meaningful relationships with their doctors, and the control of establishing such relationships lies significantly with the patient.

05:00

🤝 Understanding Patient Vulnerability

Patients face vulnerability when visiting the doctor, especially when dealing with complex issues like vision problems. The speaker highlights that, from the patient’s perspective, the doctor’s care may feel impersonal and procedural. However, this dynamic creates a distance between doctor and patient. The speaker reflects on their role as a doctor, acknowledging the need to balance medical efficiency with empathy and understanding of the patient's emotional state.

10:01

😨 Fears Beyond Medical Conditions

The speaker dives into the deeper fears that patients experience, which often extend beyond their medical conditions. These fears are linked to their identities and responsibilities—such as a truck driver afraid of losing their job or a caregiver fearful of being unable to take care of a loved one. The speaker urges patients to express these emotional concerns, as doing so fosters empathy from the doctor and strengthens the relationship.

15:05

🌟 The Power of Shared Goals and Empathy

Expressing emotional concerns as a patient can build a unique bond with the doctor, transforming them from a mere mechanic fixing a problem to a partner in achieving personal goals. When patients open up about their fears, doctors can connect on a deeper level, and this shared empathy leads to better communication and outcomes. The speaker stresses that this emotional exchange doesn’t require lengthy conversations but a genuine effort to express one’s feelings.

Keywords

💡Doctor-Patient Relationship

The doctor-patient relationship refers to the interaction between doctors and their patients, often emphasizing trust and communication. In the video, the speaker suggests that this relationship has shifted from a personal connection to a more transactional one, driven by time constraints and efficiency in modern medicine. The speaker believes the relationship can still be strengthened if patients actively engage with their doctors.

💡Confidentiality

Confidentiality in the context of the doctor-patient relationship is about protecting the privacy of a patient’s personal health information. The speaker points out that while this aspect remains important, the broader relationship has been eroded, especially in routine cases, due to evolving medical practices.

💡Vulnerability

Vulnerability refers to the emotional and psychological state a patient experiences when seeking medical care, particularly when facing serious health concerns. The speaker highlights that patients often feel vulnerable when discussing their fears, such as losing their vision, and emphasizes that sharing these emotions with the doctor can improve both the relationship and the treatment outcome.

💡Empathy

Empathy is the ability to understand and share the feelings of another person. The speaker stresses that when patients express their emotional concerns, doctors can better connect and empathize with them, leading to a more meaningful doctor-patient relationship and more personalized care.

💡Fear

Fear, in the context of this video, represents the patient's anxiety and uncertainty regarding their health, the potential loss of abilities, or undergoing medical procedures. The speaker talks about how fear often drives patient behavior and decisions, particularly in serious medical cases like vision loss, and how doctors should recognize and address these fears to foster trust.

💡Positive Outlook

A positive outlook refers to the mindset that patients have during their medical experience, which can significantly influence their health outcomes. The speaker asserts that patients who maintain a positive attitude tend to recover or respond better to treatments, and developing a strong doctor-patient relationship can foster this positive outlook.

💡Communication

Communication is the exchange of information between doctor and patient. In the video, the speaker highlights how effective communication is essential for establishing trust and understanding in the doctor-patient relationship. The speaker encourages patients to express not only their physical symptoms but also their emotional concerns.

💡Emotional Expression

Emotional expression refers to a patient's ability to articulate their feelings, fears, and concerns during medical consultations. The speaker argues that patients often hesitate to share their deeper emotions, which can hinder the doctor’s ability to fully understand their needs and provide optimal care. By expressing emotions, patients help doctors become more empathetic.

💡Outcome

The term 'outcome' refers to the result or conclusion of a medical treatment or procedure. The speaker explains that when patients and doctors work together with shared goals, they are better prepared to handle both positive and negative outcomes, knowing that they have worked collaboratively toward the best possible solution.

💡Trust

Trust is the confidence a patient places in their doctor’s ability to care for them. The video emphasizes that trust is built through empathy, communication, and understanding the emotional and physical needs of the patient. The speaker explains that trust is vital in creating a strong doctor-patient relationship, especially when dealing with complex health issues.

Highlights

The doctor-patient relationship today focuses more on confidentiality than an actual bond, and this erosion is partly due to the evolution of medicine.

Time constraints and busy schedules have led to a more transactional approach in doctor-patient interactions, likened to a 'mechanic' fixing a problem.

Patients desire a meaningful relationship with their doctors, which is evidenced by the frequent question, 'How do you say your name?' – signaling a want to connect.

A doctor's smile and patient interaction choice – to treat the person, not just the ailment – can significantly influence the dynamic of the relationship.

The patient’s emotional state plays a critical role in their experience; often, patients feel vulnerable, apprehensive, and out of control during medical visits.

Empathy from the doctor, understanding the patient's personal challenges, can shift the doctor-patient interaction from a mechanical exchange to a collaborative relationship.

Patients often fear not just losing their vision, but the larger implications, such as losing independence or their ability to provide for family, which they hesitate to express.

Expressing emotional fears like losing a job or a home enables the doctor to empathize and connect with the patient on a more human level, improving outcomes.

The doctor-patient relationship is strengthened when the patient verbalizes their emotional concerns, transforming the relationship into a partnership with a shared goal.

Patients who are able to express their concerns and feel listened to often have better overall experiences and are more likely to have a positive outlook.

A positive patient outlook is crucial for success, with research indicating that optimistic patients tend to recover better.

Even in cases of negative outcomes, a strong doctor-patient relationship helps patients handle setbacks, as both parties remain focused on the shared goal.

The doctor benefits from understanding how their care impacts patients' lives, which serves as a key motivator for them to continue their practice.

Building a strong doctor-patient relationship results in a better experience for the patient, allowing them to feel understood and cared for emotionally and medically.

To improve the doctor-patient relationship, patients should openly share their fears and vulnerabilities, which helps doctors empathize and work towards a shared objective.

Ultimately, fostering emotional openness in the doctor-patient dynamic leads to improved outcomes, both in treatment success and patient satisfaction.

Transcripts

you know there's a phrase that's not my

favorite phrase when it comes to doctors

and patients and that phrase is is

doctor-patient relationship it's not

that I don't think the doctor-patient

relationship is important I think the

doctor-patient relationship is extremely

important but I do think the meaning

behind that term has changed the

doctor-patient relationship these days

relates more to confidentiality than it

does to an actual relationship and as

medicine has evolved I think that

relationship has kind of been eroded

especially for the more routine issues

like colds and ear aches

and that's somewhat understandable but I

think that's even extended to the more

complex issues and in all honesty

there's just less time to establish a

doctor-patient relationship that we want

the good news is I think that that

relationship is more in your control the

patient's control than we realize and so

today we're going to talk about how we

established that doctor-patient

relationship and how we can use that

relationship to improve our experiences

and improve our outcomes now there's no

doubt that the doctor-patient

relationship can be difficult to

establish there's time constraints

there's busy schedules not to mention

more patients and going to the doctor

these days it's kind of like going to

the mechanic fix the problem and move

along and I can definitely admit I have

been guilty of this as both the doctor

and the patient because patients are

busy too and there's less time available

and someone question whether there's

even anything wrong with that we're

always hearing about how patients can't

get in to see the doctor they want to

see or the wait to see the doctor is too

long but there's no doubt that patients

want a strong relationship with their

doctor I know that they want and they

need a good relationship with their

doctor now the way I know that patients

want a relationship with their doctor is

the number one question that I get in

the office with

is how do you say your name it's not how

many procedures have you done it's not

how long will this take

it's not what will my recovery be like

it's how do you say your name and that's

understandable one because that's a

tough name and there's a lot of eyes and

Cays and seas but it's also

understandable and makes sense because

in order to know someone else the first

thing you want to know is their name if

you want to know about them you start by

learning their name and so when a

patient asks me that question it's it's

a sign to me that they want to get to

know more about me because they want to

know that the patient the person who's

caring for them is actually gonna care

about them they want to initiate that

relationship so patients want it and

patients need it and the way that I

realized that they need it was a recent

conversation I had with my wife we were

talking about going to the doctor and I

said are you ever uncomfortable going to

see your physician and she said no not

really one of the doctors I see is

actually a personal friend and so when I

go into the office it's not really

uncomfortable for me at all I said okay

you know that makes sense that's a

unique situation and her she had an

appointment a week or so later and when

she came home I just asked her how it

was and she said you know I was really

uncomfortable something came up I wasn't

expecting it I didn't know what to say

or how to say it so I didn't say it and

I just got through the appointment and

got home and the more the story for me

is a doctor-patient relationship is very

different than a friendship because you

might need to tell your doctor something

that you don't want to tell your friend

okay and so patients want and need this

so how do you get there

how do you develop that relationship

when your doctor has 25 other patients

to see today and you've got 25 other

places to be today

the process starts like this before I

even go into the exam room before the

patient can even ask my name I'm looking

at their chart I get a little bit of

background on what's going on with their

vision I'm mostly thinking about the

patient what are they like are they

happy or they sad do they even really

want to be here now if I'm running

behind which

ever happens then I know that they're

not gonna be thrilled already and I

always try and put on a big smile when I

go into the room and when I get in that

room I have a choice I can choose to

treat the eye which is what I am

medically trained to do kind of like a

mechanic or I can treat the patient

which requires way more experience than

you could ever get in medical school and

that choice that decision isn't entirely

up to me the patient plays a large role

in how this plays out now on the other

side of the door is the patient and

that's you or your mother or your

brother or your sister and that patient

at least in my room is having trouble

with their vision

they've been probably to one and maybe

two more doctors before they come and

see me and they've exhausted all of the

treatment options available to them thus

far so that's not really a fun place to

be

that is a very vulnerable place to be so

I could walk in the door with the big

smile on but the patient knows that's

code when I ask them how they're doing

they know that's code for we're gonna

talk about problems and nobody wants to

talk about their problems they're gonna

be poked and prodded we're gonna be

shining a lot of light in their eyes

we're gonna be asking them a million

questions it might as well be an

interrogation let me just tie your hands

and your feet to the chair we'll make it

more realistic you sit there you tell me

everything and in the end when we're

done we're gonna come up with a plan

that may very well include surgery on

your eye okay so to be a little nervous

or or out of sorts uncomfortable is an

understatement okay that the patient is

is fearful and and not knowing what's

coming up next but I can usually figure

out what's going on and usually it's

something like I'm having trouble

driving I can't see the read or I can't

see the golf ball anymore

to which I usually reply it's hard to

see the golf ball and you hit it on the

other fairway

doesn't go over that well in the exam

room but anyway I can get the gist of

what's going on with the patient and so

really what's wrong with that I know you

you're the one with the eye problem and

you know me you can say my name at least

for the next 30 seconds so let's get

this show on the road we're perfectly

acquainted and that's the doctor-patient

relationship

all too often okay but to say that there

is a boundary between myself and the

patient at this point is an

understatement

from my side I am trying to help I'm

trying to get as much information as I

can to get this person where they need

to be to fix this patient's vision but

from the patient's side I'm one step

above a necessary evil not to be given

any more information than is essential

to get the job done and we can't really

change our roles in this relationship

one of us has to be the doctor one of us

has to be the patient and we can only

partially bridge the knowledge gap but

the emotion that we bring is as large a

boundary as anything else and we can fix

that when I say we can fix it I mean you

the patient can fix it because how you

feel as the patient is really everything

and we have already established that you

probably don't feel great you can't see

we're poking or prodding we're shining

lights in your eyes so yeah you are not

feeling great you're feeling vulnerable

you're feeling apprehensive you don't

have any control you can't control the

doctors or the nurses you can't control

the outcome

all this poking and prodding we kind of

have to do it to figure out what's going

on and so for the patient the fear is

kind of driving everything the

uncertainty is driving everything there

is the fear of not regaining vision

there is the fear of losing

vision there's the fear of having a

complication there's there's the fear of

someone cutting their eye okay those are

all very objective they're all very

understandable anytime somebody's

undergoing surgery but it's more than

that

it's really so much more than that

because when you said you couldn't see

Joe what you meant was you couldn't see

to drive and you're a truck driver you

drive for a living it's the only thing

you've ever known it's how you support

your family and you can't see well

enough to do it anymore and oh by the

way your CDL license is coming up for

renewal next month and if you don't pass

you're gonna lose your job probably your

house and who knows what next

or maybe you're Sally an accountant with

two kids in college and one in high

school and you really can't tell the

difference between threes and eights

anymore on the page you've already made

a few accounting mistakes last year's

taxes and you can't really afford to

make any more or maybe you're Helen the

eight-year-old spouse of your 85 year

old husband who has Alzheimer's and

you're his sole caregiver you take him

to all his appointments except you

really can't see well enough to get

around anymore and if you can't get him

around then he's gonna be in a nursing

home and you promised him he would never

have to go into a nursing home

beyond this fear of losing your vision

is the fear of not being the person that

you need to be for yourself for your

loved ones the fear of not being the

only person that you have ever known

that's the vulnerability that is the

emotion behind the door that I am

standing in front of and that's when you

can control as the patient and the way

you control that is to give it at least

some of it to me your doctor that's what

I'm here for

that's what you need to tell me

that's what I want to hear why does it

even matter well it matters because when

you can express as a patient on an

emotional level what's going on for you

in your life then I can feel it I've

become empathetic towards you as a

patient in a way that is you distinctly

unique from every other patient we're

now working together on a goal that is

important to you when you say I can't

see to drive and I say we can fix that

then that's me being a mechanic okay but

when you say I can't see the drive and

I'm afraid I'm going to lose my house or

I'm afraid I'm not going to be able to

take care of my husband or play golf

with my kids and I can feel that it's

tangible I have a job I have a wife I

have children they are all very

important to me so I understand it and

so then my response of don't worry Joe

we are gonna help fix your vision so

that you're not going to lose your house

you're not gonna lose your job you're

gonna be able to take care of your

husband

play golf with your kids whatever it

might be it's more than just words

there's a discussion there's a motion

behind it and that emotion connects us I

can say okay let's make this our goal so

that no matter what happens our goal is

to get you to the place you need to be

to be the person that you need to be

that's what's important that's what the

patient's need to hear and you know it's

it's your ability to express your

emotion and my sense of empathy that put

us there okay

everyone has these fears if they're on

some level for every single patient some

are able to recognize it other people

bury it but if you are able to verbalize

what's going on for you it's more than

worth it

it puts you and your doctor on the same

it gives you a common goal you now have

a partner to go through this experience

with and that's the doctor-patient

relationship okay and I don't even think

it takes that much time to express what

you're feeling right it's not a therapy

session I just want to know what's going

on in your life but it takes some guts

and I'm asking you to express for you

not only what's going on with you

physically but emotionally but it's

worth putting in the time to figure that

out okay because when we're on the same

page we're working together you feel

understood as a patient when you feel

listened to as a patient because

remember how you feel as a patient is

everything so when you feel understood

and when you feel listened to then that

makes for an overall better experience

and then when you have an overall better

experience then your outlook is better

you've got a positive outlook and hands

down the patients that do the best have

a positive outlook that happens in my

office

it happens in their research it is a

fact

so sometimes it's uncanny the patient's

you don't expect patients to do as well

as they do they come in with a smile on

their face they're doing great because

they were positive from their very

beginning so if you can get there it

makes a huge difference but in medicine

and in life things don't always go well

okay it's not always a positive outcome

you might have a negative outcome you

could have a bad outcome but if you have

that relationship with your doctor then

you will be able to handle it that much

better because you'll know the person

who was working with you had the same

goal you were both working towards the

same end point and you won't focus as

much on the outcome that now is a little

hurdle you're going to focus on the goal

because the goal is still the same

if things don't go well the patience

goal is still the same to get you to be

the person that you things that you need

to do to be the person you need to be so

even if things don't go as planned

you're able to handle better and focus

on the goal the last thing the reason I

think this is important as well is that

it's important for your doctor because

the reason that I do what I do every day

is to hear from the patients about what

they can do now that we've helped them

and that's not just me that's every

physician so when a patient comes in

telling me what they can do now that

they can see how it's changed their life

that's what the reasons I get out of bed

in the morning so it leads to a more

positive outcome you can handle the

negative outcomes better your doctors on

the same page with you you've got a

common goal you're all working towards

the same thing if you can express what's

going on for you so if you want your

doctor to care about you then tell your

doctor about you with all of the emotion

that's going on what you're worried

about what your fears are what your

vulnerability is it'll get you on the

same page you'll develop that

relationship the whole experience will

be tremendously better and that's what

you wanted in the first place that's the

reason you asked me my name thank you

you