Americans don’t always trust their doctors, and here’s the proof: a 2012 survey found that just 34 percent of U.S. adults said they had “great confidence in the leaders of the medical profession” -- a significant drop from 76 percent in 1966.
A 2015 study from ZocDoc confirms this widening distrust of medical professionals. According to the study, 30 percent of women and 23 percent of men have lied to their doctors through omission, or by telling “white lies” -- most often in response questions relating to diet and fitness routines and smoking and alcohol use -- due to embarrassment or time constraints.
The state of the doctor-patient relationship seems perplexing, until we closely examine what's happening in the exam room.
Thirty percent of women and 23 percent of men have lied to their doctors. Image Credit: Anchor Point
Doctors and patients struggle to make authentic connections between one another. Both parties feel rushed during the typical 15 minutes of “appointment time,” which is inadequate for real relationships to form. A 2001 study at the University of South Carolina found that primary care patients had only 12 seconds to speak before being interrupted by their physician, which doesn’t bode well for anyone -- especially a shy person who’s a little nervous or embarrassed about his or her, ahem, situation … whatever it may be.
The Hard Questions: How Can Doctors Earn (And Keep) Patient Trust?
Tess* made an appointment with Dr. James Doty, clinical professor in the Department of Neurosurgery at Stanford University and the Director of the Center for Compassion and Altruism Research and Education (CCARE) at Stanford University School of Medicine, to address her chronic back pain. After visiting several other doctors, Tess wanted another opinion regarding a recommendation she’d gotten from a previous doctor to undergo spine surgery. But after their initial meeting, Doty was convinced there was more to the story.
“She was overweight, she was stressed, and the bangs hanging in her eyes made it easy for her to avoid eye contact,” Doty says. “As I spoke with her, I could tell there was more going on than simply her back. She had something called dyspareunia, which is pain with intercourse. I also noticed she had scars on her wrist.”
Instead of sticking with routine protocol, like, “throwing her X-rays [up on] the wall,” Doty says, he prodded further. In their conversation he learned she had a long history of unhappiness and sexual abuse -- Tess had been raped by her stepfather at age 12. Doty came to the conclusion the 28-year-old woman wasn’t just suffering from back pain. She was chronically unhappy, struggling with weight management, and was unable to have satisfying intercourse.
“Not a single doctor had sat down and asked any of the important questions,” Doty explains. Of course, Tess hadn’t necessarily volunteered this information, either, making it even more important for Doty to establish his trust. Instead of scheduling the surgery, Doty referred her to a psychiatrist.
After six months of psychiatric treatment, Tess had lost weight and was back-pain-free.
“This is the difference between really listening, and doing it the easy way,” Doty says. “If your patient feels rushed, if they feel you’re not really with them, or that they’re just another number, you won’t establish that trust you need to create a connection where your patient feels you truly care, and vice versa.”
The Doctor-Patient Relationship Begins In Medical School
"When patients are in a difficult spot and struggling, they want some kind of affective or emotional presence,” Post says. “There needs to be some dimension of -- if you will -- heart.” Image Credit: Anchor Point
In the case of medicine, it’s a disservice not to offer courses that focus on empathy, communication and relationships, according to Emiliana Simon-Thomas, science director at the Greater Good Science Center. “Imagine telling someone they were going to compete in the Olympics as a runner, but rely on life experience to prepare them,” Simon-Thomas says. “Here we are putting [new doctors] in a position where they are confronted with pain and suffering all day. To not prepare them for that is unfair.”
Educators in the medical field agree, and more and more medical schools have started to incorporate the doctor-patient relationship into the curriculum. Emory University Medical Center, Duke University Medical Center and Stony Brook University School of Medicine offer training in “medical humanism.” Oncotalk, a course required of Duke’s oncology fellows, and Empathetics, a series of online courses for physicians, are part of a larger effort to teach doctors clinical empathy and improve the relationship between patients and their doctors.
At Stony Brook, a mandatory course guides future clinicians, doctors and nurses to pay more attention to the fine details of a patient experience. Students learn how to build a better connection with patients, express empathy and learn the art of attentive listening, Stephen G. Post, Ph.D., director of the medical school’s Center for Medical Humanities, Compassionate Care and Bioethics, says.
“We teach students how to respond empathically to patients; ask questions not just about their history of disease, but how they are coping with their diagnosis and what they’re most fearful of,” Post says.
Students run through real-life simulations with actors playing patients, which require them to use their new listening and sympathy skills, and feedback is provided.
Post admits that in reality, these “scripts” can be purely cognitive, or recited mechanically -- but that’s not enough to cut it as a trusted professional in the medical world. “When patients are in a difficult spot and struggling, they want some kind of affective or emotional presence,” Post says. “There needs to be some dimension of -- if you will -- heart.”
The Science Behind Compassionate Care
The proof is in the medical reports: Adding empathy and compassion to the equation improves patient outcomes. Studies show that a positive doctor-patient relationship can have significant effects on health outcomes like obesity, diabetes, hypertension, asthma, pulmonary infections and osteoarthritis pain. Research also shows that when health care workers treat patients with compassion, they often have lower blood pressure, have less pain and anxiety, and even heal faster.
Related studies in 2011 and 2012 found that diabetes patients of doctors who scored higher on a test of empathy were less likely to have complications associated with their condition than patients of doctors who scored lower on the test. The results further confirmed how physician empathy can positively impact patient outcomes.
As in Doty’s example, a doctor’s ability to connect with his or her patient can also make identifying the real problem easier.
“When clinicians make these kinds of empathic connections with their patients, when they don’t interrupt them, when they are comfortable with moments of silence, when they can pause a little bit when they see their patient is getting emotional, you see much better diagnostic accuracy,” Post says. “When patients feel that kind of security in a relationship, they are able to say things about themselves that are diagnostically relevant that you never would have come up in a more formal-type questionnaire.”
The New Focus On The Patient Helps, But Let’s Not Forget About Physicians
With initiatives like those at the university level in place and growing, there is reason to believe the future of medical care can only improve. The problem? Physician burnout is trending.
“There’s an incredible problem of physician burnout and depression,” Post says. “Last year, 500 to 600 doctors in America killed themselves. Forty to 60 percent of physicians are unhappy with their professional lives.” (While no hard data exists, it’s reliably estimated that at least 400 physicians commit suicide every year.)
According to Post, most doctors who report unhappiness with their professions chalk it up to the fact that they can no longer connect meaningfully with their patients. Several workplace pressures, including health care systems’ protocols such as HCAHPS (a survey instrument and data collection methodology that’s basically a ‘Yelp’ for hospitals), loads of billing paperwork and financial obligations, often push doctors to rush through their patient load, leading to dissatisfaction. In short, physicians need some TLC, as well.
“When you’re deprived the time to connect with your patient and hear what they have to say, that’s intrinsically frustrating,” Simon-Thomas explains. “It’s a dismissal of one’s agency, and can erode a doctor’s sense of efficiency. It can also set them up for failure.”
Ultimately, the system needs to change, Doty explains. As it stands, the medical system doesn’t allow true human connection.
“We have the most expensive health care in the world,” Doty continues, “with the highest level of patient dissatisfaction …. we spend lots of money on useless tests, inordinate amounts of money to do things that are clearly not beneficial, but no one will say, ‘Let’s give this doctor 20 minutes more for each patient so they can take the time to ensure that we nurture our healthcare providers by having programs that are supportive and improve resilience.’ Now that would be cost-effective.”
What Everyone Can Do To Improve Outcomes
Since we can’t override America’s health care system, the best thing we as patients can do is return the favor.
By attempting to understand the stresses doctors are under -- like taking into the account the heavy paperwork and endless swinging door of patients they have to deal with on a daily basis -- we can act more compassionately toward our health care providers.
“No one likes to feel discarded or rushed, whether they’re a patient or a physician,” Doty says. “To improve the lives of everyone around us, we all need to be empathetic."
Dignity Health would like to extend their thanks to the Center for Compassion and Altruism Research and Education (CCARE) at the Stanford University School of Medicine for their partnership. Dignity Health is on a mission to infuse more compassion into health care, and throughout our daily lives. When heart and health go hand-in-hand, amazing outcomes are possible.
*name has been changed to respect patient confidentiality