5 recommendations to improve doctor-patient relationships


Researchers at Stanford University (United States) have been studying for more than two years how to solve the growing fracture in doctor-patient relationships. They consider that it is not good for patients or doctors that they feel increasingly disconnected from the reasons why they decided to dedicate themselves to medicine, as published in the journal ‘JAMA’.

The objective of their research, which began 2 and a half years ago, was to identify evidence-based measures that doctors can take to fully engage with patients and understand their perspectives, life circumstances and priorities. Ultimately, the researchers wanted to generate a short list of highly effective practices that doctors could easily incorporate into their interactions with patients, explains Stanford’s doctor, Donna Zulman.

In recent surveys, doctors have recognized that the current climate of medicine, with limits on the amount of time they can spend with patients during appointments, the explosion of biomedical knowledge and the increased demands to update and review electronic records of health, translate into less time for meaningful interactions with patients.

Thus, in their article, researchers have managed to compile five evidence-based recommendations, which are:

Prepare with intention: familiarize yourself with the patient you are going to meet and create a ritual to focus your attention before a visit.

Listen carefully and completely: sit down, lean forward and position yourself to listen. Do not interrupt your patient because it is your most valuable source of information.

Recognize what matters most: discover what matters to your patient and incorporate these priorities into the visiting agenda.

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Connect with the patient’s history: consider the circumstances that influence your patient’s health, acknowledge their efforts and celebrate their successes.

Explore the emotional cues: tune in, note, name and validate your patient’s emotions to become a trusted partner.

This research was conducted in conjunction with Presence, an interdisciplinary center in Stanford that promotes the art and science of the human connection in medicine. The objective of the research project was to review the critical moment in which doctors and patients are, changing the emphasis of the institutional procedure to an interaction focused on meaningful human interaction.

“We were looking for practices that would improve patient experience and lead to better care for them, but they would also improve the experience of doctors and help them rediscover the joy of medicine,” explains Zulman, assistant professor of medicine and director of medicine. Stanford Presence 5, one of the Presence initiatives.

“As doctors, we have the privilege of working with people in their most vulnerable moments,” he explains. “And in today’s climate, particularly in primary care, it’s easy to lose sight of that with all administrative demands, time pressures and distractions. technological. “

Zulman, a health services researcher at Stanford and the Veterans Affairs Health Care System, is the lead author of the article, and Abraham Verghese, advocate for the importance of bedside medicine and physical exams, is the Main author of the article.

Presence 5 practices, as they are known, were identified through a systematic review of 73 studies of interpersonal interventions published between January 1997 and August 2017, as well as through observations of doctor-patient meetings and interviews with doctors and patients at the Stanford family medicine and internal medicine clinics, the Ravenswood Family Health Center in East Palo Alto and the Palo Alto Veterans Health Care System.

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The team also interviewed professionals outside the medical field to learn about cross-cutting issues related to the presence of the clinician and the human connection.

Published studies were analyzed to measure how interventions improved health outcomes, costs and experiences of patients and doctors. Interviews and observations provided information on best practices at the clinical level.

The information that the researchers obtained from the studies, interviews and observations generated 31 ideas for the practices that doctors could implement, which were reviewed, qualified, selected and summarized in five with the contribution of a group of experts composed of doctors, researchers, a patient advocate, a caregiver advocate and health care leaders.

Zulman advances that the next step of the team is to evaluate how the use of these five practices affects the experiences of patients and doctors, with new research being carried out at the Stanford Primary Care Clinics, the MayView Community Health Center , in Mountain View, and the VA Clinic of San José, which is part of the VA Palo Alto health system.

Researchers are conducting workshops to share their findings, and they are also developing a curriculum to train medical students and residents. The team is also working to validate their findings with international collaborators and to determine if the practices can be adapted for different environments and clinical models.

“The Presence 5 practices stand out because they talk about something that is timeless and central to medicine – Verghese points out. – Patients want us to be more present. And we, as doctors, want to be more present for our patients, because without that contact our professional life loses a lot of its meaning. “

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Zulman notes that researchers see Presence 5 measures as just one step to address frustrations with modern medicine. “While we may not be able to change the system overnight, our study suggests that there are some concrete evidence-based strategies that we, as doctors, can use to help preserve and foster connections that are more healing for the patients and for us, “he concludes.

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