Optimizing the Patient/Physician Relationship 

Part  4  of  a  Series

Achieving the loyalty of patients and getting them to adhere to treatments all boils down to doctors showing they are friendly and truly care about their patients

In the last installment of this column (August 2012), I presented the physician/patient relationship as the most critical factor affecting adherence to treatment. Patients want and expect to see a caring, friendly doctor and, contrary to much public opinion, doctors are caring, friendly people. But what determines whether patients are satisfied is not whether the doctor is caring but whether they believe they are seeing a friendly, caring doctor.

I am not suggesting that doctors are, can be or should be unfriendly and uncaring. What I am saying is that friendly, caring doctors who do not appear caring and friendly are not optimizing their relationship with patients, will not have optimized patients’ adherence to treatment, and will not have optimized their patients’ treatment outcomes. In other words, unless the physician appears to be friendly and caring (in addition to actually being that way), the physician is not practicing good medicine.

If I were to rush into a patient’s room, make a quick and accurate diagnosis, and immediately suggest what treatment to use (the way I used to do), the patient is likely to think I didn’t care enough to do a thorough examination. He or she might believe the treatment is not trustworthy and poor adherence to treatment is a likely result.

The diagnosis may be obvious. The treatment may be standard. But patients must feel they are getting great care. This may take a bit of a “show.” To start, I open the exam room door slowly, even if I just ran up to the door to save time. If the door is opened too fast, the patient will assume the doctor is rushed, even if the doctor isn’t rushed.

Before any prescription is written, the doctor must do whatever is needed to make sure the patient feels he or she had a thorough examination. Touching a rash communicates that the doctor cares and that a thorough examination has been done. Pulling out a lighted magnifier and pretending to study a lesion can communicate that a thorough examination was performed. I often wonder if family physicians and internists get any useful information from their stethoscopes or whether they lay it on just to communicate that good medical care was provided.

Giving patients a chance to speak is critical. I like to say to patients, “I bet you found the previous treatment ineffective and frustrating.” This statement communicates to patients that the doctor understands their condition, appreciates its impact and cares to listen to the patient. I get no information from patients’ response to this question. Patients always respond in the same way, “Yes, the previous treatment was frustrating and ineffective.” Had the previous treatment been effective and encouraging, the patient wouldn’t be sitting there with a rash.

Looking the patient in the eye, offering a friendly handshake, and making with a little banter about the patient’s work, hobbies or other life activities helps establish that the doctor cares about the patient as a human being. The result is better adherence with the patient much less likely to worry about side effects, and they won’t want to let their doctor down by not taking (or not even filling) their prescribed treatment.

Now that the patient knows the doctor is caring, the prescription—one that may have been determined by a brief glance from the door of the exam room—can be handed to the patient. This is another critical moment in achieving good adherence to treatment, one that requires addressing several issues. We’ll cover those in the December issue.

  • Steven Feldman, M.D.

    Dr. Steven Feldman is Professor of Dermatology and Public Health Sciences at Wake Forest Baptist Medical Center. Steve studies patient adherence at North Carolina’s Wake Forest Baptist Medical Center. He is also Chief Science Officer of Causa Reseach, an adherence solutions company (www.causaresearch.com), founder of www.DrScore.com, and author of “Compartments” and “An Illustrated Dictionary of Behavioral Economics for Healthcare Professionals.”


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