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Transforming the Patient-Provider Relationship

Transforming the Patient-Provider Relationship

These days, it’s hard to be a doctor.

Not only are there not enough hours in the day to help everyone who needs to be helped, but the pressure to integrate new medical information, treatments, and technologies–– on top of a broken patient-provider relationship–– can leave many doctors feeling frazzled, endlessly busy, and lost in a maze of billing, while still feeling they aren’t doing enough.

It’s no secret that our healthcare system has its flaws. But rather than letting the chaos undermine your practice, we’re outlining a few simple tips to help you transform the way you “show up” to your practice–– starting with the patient-provider relationship.

Why is Transforming the Patient-Provider Relationship Important?

Many would agree that a patient’s potential to “get better” relies on a combination of quality treatment options and a patient’s own sense of agency to follow through. As a doctor, you can provide the best treatment in the world, but if it’s not matched with a patient’s integration of healthful patterns into their life–– chances are they’ll end up back in the exam room.

Here at TelMD, we see the patient-provider relationship as foundational in making any real progress–– not only for patients, but also for practitioners’ own sense of well-being, and the success of their practice. 

After all, when the patient-provider relationship is broken, doctors might feel:

  • Frustrated and impatient with their patients 
  • A sense of purposelessness and lack of passion for their practice
  • A lack of “presence” when they sit with their patients
  • Upset by negative reviews or stunted growth in their practice

Conversely, when the patient-provider relationship is in a positive balance, doctors can feel:

  • Excited, enthusiastic, and passionate about their practice
  • Compassionate, patient and understanding with their patients
  • Satisfied by the results of their efforts when patients make progress and experience true healing
  • A steady stream of referrals and a constantly growing practice
  • Inspired and enlivened by new science and medical information

So, are you ready to radically improve your practice with a healthier patient-provider relationship? What follows is a blueprint for such a transformation. 

The Problem with the Conventional Patient-Provider Relationship

If you’re not seeing an overall increase in positive outcomes for your patients, it’s possible that you might be falling into some of the traps associated with the conventional patient-provider relationship. We’ve outlined some of these shortcomings below. 

Not Enough Time

When doctors pop into an exam room for a few minutes to methodically confirm a diagnosis and prescribe treatment, they’re often only exposed to a fragment of the problem. Whereas, to prescribe the best treatment, the diagnosis could usually benefit from a more expansive or “holistic” view of what’s “wrong” with a patient. If you’re only in the exam room with your patient for a few minutes, the chances of your patient opening up to tell you the whole story of what’s going on for them are slim to none.

“I’m the Expert, You’re the Patient”

Doctors and patients alike are often trained to take on, and stay in the following roles: I’m a doctor and I know everything, and I’m just a patient who knows nothing–– fix me!

The truth is, neither doctors nor patients benefit from staying in these roles, as true sustainable health flourishes with a less hierarchical relationship. Of course doctors are the medical experts, but each patient is their own body’s primary “expert.”  Patients live in their bodies, feel what’s happening in their bodies, and are responsible for what goes into their bodies, and what they do with them every day. We can think of this as an incredible wealth of untapped data–– that could greatly influence how we diagnose and prescribe treatment.

So by empowering patients to be the “experts” of their own bodies, conditions can be more clearly assessed, and treatments can become more precise. 

Lack of Cultural Responsiveness/Open-Mindedness

The number one way to empower our patients? Listen to them. But, if patients sense that they will be judged for what they say, they are less likely to be forthcoming with personal information that may be needed to diagnose and prescribe appropriately.

Every patient comes from a different cultural background and understanding of health and healing. In fact, in 2012, up to 30% of adults used health care approaches that are outside of conventional medicine and that number has increased over the years. Some turn to traditional healing methods like prayer and meditation, and others are likely to seek out “natural” or “alternative” approaches like acupuncture, homeopathy, or Reiki. 

As we all know, studies show that our beliefs and attitudes about healing can have a measurable impact on how we heal. In other words–– the placebo effect. Say what you will about placebo, but with an ability to reduce pain up to 30%–– it’s not to be dismissed.

So rather than automatically discounting anything but conventional medicine, a more comprehensive approach can involve listening to a patient’s self-appointed decisions for what will help them feel better, and heal (as long as they’re safe).

Don’t get us wrong, we’re not suggesting that you don’t prescribe the conventional treatment you think will work best, but allow it to be in collaboration with safe alternative treatments. Usually, the danger with most alternative treatments arises when people rely on them in isolation–– not in combination–– with conventional doctors and treatments. “Complementary Medicine,” is increasingly being embraced in cutting-edge facilities across the country. 

Transforming the Patient-Provider Relationship

A Better Patient-Provider Relationship

So, what does a better patient-provider relationship actually look like, in practice?

As a Functional Medicine doctor with 18+ years of experience in helping patients heal, (and the man behind telmd.com), Dr. Terry Franklin has a few ideas. The tips below are informed by his signature approach to what he calls “Appreciative Medicine,” or a patient-centered form of care. 

1. Listen

First and foremost, always and repeatedly–– do more listening than you do talking. If patients are hesitant to open up, ask questions and give them the proper space to open up. An important note—“listening” isn’t just being quiet and nodding your head–– it involves the art of truly allowing your patients to feel heard–– without judgment. 

We know this can be difficult, but think of it as a practice. You might not immediately be great at it, but if you keep trying, you’ll feel so much more satisfaction and see results. Not only in your patients’ healing journeys, but also the natural growth of your practice. Once a patient finds a doctor who listens, they are likely to share the news with their friends and communities. 

Finally, as doctors take in all of the seemingly unrelated details about their patients’ lives, it helps paint a better picture for them to correctly prescribe a treatment plan that will actually work for them— and that they’ll be more likely to follow. 

2. Focus on the Solutions

Part of the reason why practitioners feel so burnt out is because it is exhausting to listen to people’s problems all day–– especially with no end in sight.

Interrupting the “complaint” dynamic by instead focusing on the solutions immediately brings a more positive feeling into the room. Asking patients questions like, “How do you want to feel? or “How would your life look differently if you felt that way?” can help generate excitement from them. When people visualize what healing looks and feels like for them, it makes it more personal, while creating the motivation for them to want to work towards it.

For instance, if a 65-year-old man is suffering from high blood pressure that could be lowered through diet and lifestyle shifts, he might “know” that he “should” lower his blood pressure. He might even “know” what he “should” be eating, how he should be exercising, and what he should be doing differently.

But knowing is one thing. If patients lose sight of their “why,” they are less likely to follow through on the “how.”

So if instead, the man is asked how he wants to feel, and how his life would look differently if he had lower blood pressure, he might say something like, I’d feel like I could run, exercise more, and have more energy without being afraid of a heart attack. I’d feel like I could really play with my grandkids and be around for them for a while instead of worrying about my declining health.”

Further, when patients are asked to self-identify solutions, it might sound something like this. “Well, I guess if I eat a little healthier and get more exercise my blood pressure will probably go down…” When they name the solutions that might actually work for them, they are more likely to actually embrace and follow through with them, than if you are just the 16th person to tell them what to do.

That’s why most coaching professionals take this approach of asking a lot of questions. It’s psychology, and it just works. 

3. “Partner” With Your Patients on Their Healing Journey

When practitioners think of themselves as partners on patients’ healing journeys (rather than as their “healers”) it shifts the fulcrum of responsibility from 100% on the doctor and 0% on the patient–– to more of a 50%/50% relationship. 

Not only does this immediately relieve the practitioner from an unrealistic expectation of efficacy, it encourages the patient to engage in their own healing journey, which the research shows is incredibly important for any particular treatment to “work.” 

It also allows them to take a more curious approach to a patient’s healing journey–– rather than a “this” or “that” approach. In a world where 80% of many chronic ailments can be fixed through diet and lifestyle shifts, the truth of the matter is–– getting into a healthier place is often a matter of shifting multiple levers–– not just one pill or one treatment.

So by taking a curious approach to the journey of healing, patients are encouraged to listen to their bodies, see what works and what doesn’t for their lives, preferences, and schedules, and keep trying different things, they identify the correct combination of factors that provide relief. 

An Example of a Healthier Patient-Provider Relationship 

For the most part, health care providers currently assess patients with a formula known as “SOAP” (Subjective, Objective, Assessment, and Plan). This problem-treatment approach may work well enough for certain acute conditions, but here at TelMD, we recommend a more comprehensive model with a healthier patient-provider relationship. We refer to this as the  “SOA2R” model (Solution, Objective, Assessment, Action, Reinforcement of possible solutions).

Here’s an example of how it’s done.

Marcus Smith is a 44-year-old patient with a history of chronic lower back pain. He’s seen his primary care physician at least 8 times a year with exacerbated pain, and he was told a few years ago that his cholesterol was high but is confused about what that means. He cannot remember ever having a physical exam as an adult.

Subjective: Low back pain

Objective: Multiple trigger points; decreased range of motion; reflexes intact. 

Assessment: Lumbar Strain

Plan: Analgesics, muscle relaxants, return in 2 weeks if symptoms persist. Acupuncture and chiropractic adjustments, and/or herbal remedies. 

What might be missing from Mr. Smith’s treatment plan?

Clearly, this case would look different in a SOA2R model, or with a healthier patient-provider relationship.

First, Marcus would derive the Solution (e.g., an affirming statement or goal) through in-depth self-reflection. In other words, it is not necessarily the foremost medical opinion of the attending physician. 

Second, the Objective supports what patients themselves see as being true, not necessarily what practitioners may observe as problems to correct.

Third, health care providers and patients achieve the Assessment phase together, in which they agree on what Action is to be taken.

Finally, Reinforcement supports patient-doctor collaboration and does not automatically, or of itself, dismiss or supersede conventional methods of treatment. 

Solution: My back pain has resolved. I feel stronger than ever. How can I keep feeling strong and flexible?

Objective: Range of motion normal; strength good; flexibility increased.

Assessment: Continue with back-strengthening exercises. Recommend stretching and swim therapy.

Action: Take a course in yoga and be conscious of posture.

Reinforcement: Walk daily. Learn more about the Mediterranean diet. Update tetanus-diphtheria. Schedule yearly physical and have appropriate blood and laboratory testing.

In Conclusion

As we shift from a “sick care” system to a “health care system,” transforming the patient-provider relationship is an integral piece of this puzzle.

Not only does putting the power back in patients’ hands have a tremendous impact on their potential to follow through with treatment and seek results instead of an endless journey of pain management, it can rejuvenate the health care provider’s passion for their practice again—making them feel healthier themselves, while naturally growing their practice. 

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