Coaching in Health Care: The Patient-Physician Relationship and the Role of the Physician Leader

The ideal patient-physician relationship is based on four tenets.  The first is effective and equal communication, in which each party clearly values and understands the other.  Second, the physician must display empathy and emotional support for the patient. Third, the physician must view the patient as a “whole” human being and not just a person with a malady. Ideally, the physician knows something about the patient’s background that forms the patient’s personality. The first three principles form the foundation of the fourth: mutual trust.  The physician and patient, by fulfilling the first three tenets, will develop the mutual trust that binds the relationship to ensure its success.

In all fairness, before managed care became the dominant healthcare delivery model in the US, patient-physician relationships were not always ideal. In managed care, the patient-physician relationship was further weakened primarily due to the decrease in time patients and physicians interact. Physicians who participate with managed care spend less time with their patients.   Also, physicians offer less explanation to the patient of their health problem and medical care.   Poor indicators of effective communication.

This change in their relationship has also resulted in changes to each of the parties, and not for the better.  The physicians’ pressure to see a greater number of patients have led to an increased stress level.  In a survey of 2,700 physicians, Shapiro and associates showed a direct correlation of the percentage of managed care patients in a practice with a physician’s stress level. For patients, since medical decision making is related to the length of office visits, the decreased time results in patients having a decreased role in their medical decision process.

The quality of the patient-physician relationship is directly correlated to the success of the outcome of care for the patient. In 1998, Safran and associates evaluated seven defining elements of the primary care physician relationship with their patient. Three of the defining elements are of particular interest, as they are at the core of the patient-physician relationship: physician interpersonal care of the patient, physician knowledge of the patient and patient trust of the physician. In this study of over 6,000 patients, researchers correlated these defining elements to three outcomes of patient care: patient adherence to the primary physician’s advice, patient satisfaction and improved health outcomes.