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Physician Patient Rapport, Part I
Just about everyone has had the experience of a getting a good night’s sleep, waking up early and getting a few things done before actually going to the office or hospital and beginning to see patients. The day is going well and you are feeling on top of all your responsibilities. But then somewhere along the way, a patient or a staff member, or perhaps even a well-meaning colleague remarks " Gee…you look kind of tired."
With that statement, suddenly every neurological connection within your control immediately shuts down. Your heart begins to beat a little faster, you get a lump in the back of your throat, and at the first chance you get, you head to the mirror to see just how "tired" you look. You think to yourself, "I’m feeling all right. You know I’ve never really liked that person anyway!"
So what has happened here? Aside from the obvious, why was this interaction so annoying?
What’s taken place, is that you’ve just experienced a sudden mind-body incongruence. Leaving out a lot of psycho-babble, let me simply say that your brain has been feeding your subconscious mind positive and helpful information filtered through its myriad of sensory inputs… then from out of nowhere you’re confronted with some incongruent information telling you just the opposite of what other input had led you to believe.
For most of us it’s easy to delete incongruent information. On the other hand we know from experience that information from a face to face encounter with another human being is to be taken seriously. Making an analogy, if you were a computer, this kind of input would trigger a system overload. Your internal program couldn’t compute this information and a big window would pop up in your mind saying "General Protection Fault #9 - Please Restart System".
You then have to take a moment to let your brain re-acquire information about yourself. You shake out your arms and legs. You stand up straight and scrutinize your face in the mirror. If you like what you see and feel, you tell yourself in a sub-audible way …"Hey I don’t look or feel so bad." You reestablish congruence by telling yourself that the person who so impolitely interrupted your day was nothing more than an imperceptive clod. Finally, you can go about your business and get some work done.
A more useful way to characterize this episode is to say that you and your erstwhile friend, colleague, or acquaintance failed to establish rapport. This word "rapport" will take on critical meanings which I’ll expand upon later, but the importance of good rapport is evident from the example. When rapport is absent, even a well meaning and empathetic gesture or remark can have a profoundly negative influence on all subsequent communication and perception between two individuals.
In fact, without rapport, all communication comes to a grinding halt! Each person is usually busy in his or her own mind with a lot of internal dialogue that generally tries to negate everything the other person is saying. To return to our computer analogy, it would probably be better if one could simply click the power button off and on and start the whole interaction over again.
Unfortunately in the doctor patient relationship of today, we don’t have much time for a second chance. When you allow ten minutes for a GYN visit and 5 minutes for an OB check, you don’t want to make many mistakes. The point is that when it comes to an effective doctor-patient relationship, the very first responsibility of a good physician is to establish a line of communication. Without communication, especially in the field of OB/GYN, it is like trying to work blindfolded with your dominant hand tied behind your back.
In this era of managed care, the assault on the physician patient relationship is in full swing; we have lost both fiscal and intellectual control. Yet many of us feel that a critical element in regaining control of our profession lies in the caring and maintenance of a good relationship with our patients. If doctors are to ever be entrusted with the public’s confidence again, it will only come at the expense of learning the techniques of establishing rapport, developing lines of communication, and maintaining measurable quality outcomes. All too often we are more comfortable with working strictly on our outcomes. Communication takes a back seat.
Although many of us with successful practices have learned how to relate well to our patients, it has not been an easy or painless process. Often it takes years of unconscious trial and error. Most of us don’t even think about exactly what we do to establish rapport when we first walk into a patient’s room. We do what comes naturally. Today however, especially for OBGYN’s of the male gender, establishing effective and immediate rapport is a critical element in quality patient care. How that rapport is developed, and the steps required to quickly test a level of rapport are key pieces of information we need to take into the doctor patient relationships of today. In Part II we’ll talk about how that’s done.
Douglas J. Krell MD FACOG
Galisteo OB/GYN Associates PC
Santa Fe, New Mexico
OBGYN.net State Representative, New Mexico
douglas.krell@nsionline.com
