The More You Know Your Patient, the Better Care You Can Give

Cleveland Francis, Jr., MD


April 04, 2022

In my 40-plus years as a clinician, I have found that a strong, empathic physician-patient relationship builds the trust that is fundamental to successful patient care. The best way to achieve that trust is by taking the time to get to know a little more about my patients. Showing that I was interested in them as individuals made our bond stronger, and I am convinced that this resulted in better outcomes. 

When we review patient satisfaction surveys, we find that there is always room for improvement. It is convenient to blame low scores on survey sample size and other factors, but the results tend to be consistent and are unlikely to change unless we make a fundamental change.

Patients give us good reviews if we provide an expected level of service: minimizing wait times, treating them with dignity and respect, and providing appropriate therapies. These fall under the heading of customer service and are essential but recognizing patients as individuals and showing interest in their lives beyond their disease exceeds expectations and promotes the excellence we strive for. 

Instead, we create faceless "avatars" of patients in the EMR, eg, "Jane Doe is a 63-year-old Black woman with atrial fibrillation." With copy and paste, this avatar represents the patient in all future encounters and changes only with a birthday or additional diagnoses.

We were taught the importance of the "patient's story" in medical school, but we seldom use it now. There are many 63-year-old women with atrial fibrillation, but only one who has a granddaughter named Amie who is about to graduate from nursing school. Knowing this not only builds rapport and trust but can also lead to a more personalized treatment plan with better results. 

Source: Sophie Collier/Maybelle Kou MD

A personal connection with the patient is an important principle in the "art of medicine" and fundamental to the clinician-patient relationship. It establishes the foundation for much of what follows. Engaging in these conversations shows the patient that we see them as more than their diagnosis and contributes to a different level of respect as patients navigate through our impersonal, fast-paced, EMR-driven system.

Medical encounters are dynamic and have several players: the care team and clinician; the individual with a disease; and the ever-present computer that takes away essential eye contact. An individual with a disease becomes a patient once there is an association with the caregiver. But association alone is not enough; there must be a connection. Then, and only then, can empathy from the caregiver and trust on the part of the patient develop. The connection may not be complete after the first encounter, and more information may be collected over several encounters 

Connection Pause

I recognize that time is an issue, but the following will add very little time to patient encounters. 

For new patients, I suggest that we take what I call a "connection pause" before getting into the specifics of their condition. Take 2-4 minutes to sit at the same level as the patient, look them in the eye and talk about things that have little to do with what brought them in to see you: family and living arrangements; occupation; education; and if possible, a little about exercise and hobbies: Do they follow a sports team? Have they ever served in the military?  

This will present a clearer picture of the patient and can be included in the visit summary so it's available to other members of the care team. 

Source: Cleve Francis MD/Maybelle Kou MD

The initial conversation should not be forced. An informal give and take may not come naturally to some of us, but it can be learned. Investing in clinical empathy training is money well spent. 

Even if you are aware of the pervasiveness and insidiousness of implicit bias, it is still easy to fall into the trap of making assumptions about someone on the basis of their appearance. Personal information about patients can help counter this bias. An added benefit is that knowing our patients on a more human level enriches our lives as well. 

It is challenging to empirically evaluate improvement in outcomes through a more personalized approach. My institution is developing plans to gather data to test the hypothesis that time spent on learning more about patients as individuals will lead to greater patient satisfaction and improved patient experience. (I will report on the results in a future blog.)

I decided many years ago that wearing less armor and being more vulnerable would help me take better care of my patients. This meant getting to know more about them; in turn, I allowed them to know more about me. I have never regretted that decision. Less armor and more vulnerability might put the fun back into seeing patients and help counteract burnout. 

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About Dr Cleve Francis
Cleveland Francis, Jr., MD, Diversity, Equity and Inclusion Advisor; Inova Heart and Vascular Institute (IHVI), Falls Church, Virginia; Former president and founder, Mount Vernon Cardiology Associates; Chair, IHVI Committee on Equity, Healthcare Disparities, Education and Outreach; Member, Inova Inclusion Counsel

Dr Francis is also a songwriter and performer. He is a former recording artist on the Capitol Nashville Country Music Label (1992-1995), and his music has been featured at the National Museum of African American History and Culture in Washington, DC.

Connect with him:
Twitter: @muzicdoc2
Facebook: Cleve Francis
Instagram: @muzidoc


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