How To Master the Doctor-Patient Relationship

The doctor-patient relationship has been the focus of sociological and philosophical debate since the days of Hippocrates. It’s also the subject of thousands of modern medical articles, monographs, and books.

According to The National Library of Medicine, patients who ask questions and engage with their healthcare provider have better health outcomes, more satisfaction, and a higher quality of life. When holistic medical education helps clinicians refine their communications skills, they’re able to win patients’ trust and improve doctor-patient communication. When every patient interaction matters to you and every decision respects your patient’s autonomy, you know you’ve mastered the doctor-patient relationship.

Why the doctor-patient relationship is the keystone of healthcare

Regardless of age, gender, or health condition, a doctor’s visit can make anyone feel vulnerable. During a meeting with a healthcare provider, patients may share intensely personal and private information — sometimes even worries and fears that they have not yet shared with their closest friends or even family members. For this reason, the profound relationship between a patient and their physician must have a strong foundation.

The doctor-patient relationship is the channel through which healthcare providers gather data, make diagnoses, craft care plans, ensure compliance, and monitor a patient’s health. It’s where patient activation, support, and healing begin and end. To improve the doctor-patient relationship is to be a savvy business person as well — people are loyal to healthcare organizations where they enjoy good communication with general practitioners and specialists alike.

Luckily, communication skills that enhance the doctor-patient relationship can be learned and honed — once clinicians maneuver past some common barriers.

What is the structure of the doctor-patient relationship?

In their groundbreaking article from 1956, Szasz and Hollander outlined three basic models of the doctor-patient relationship: 

Active-passive model

This is the oldest of the three models. It is based on the physician acting upon the patient, who is treated as a non-communicative subject. This model may be appropriate in an emergency when the patient is unconscious or when a delay in treatment could cause irreparable harm. In such situations, consent is waived. 

Guidance-cooperation model

In this model, the doctor is placed in a position of power because they have medical knowledge that the patient lacks. The physician is expected to decide what is in the patient’s best interest and make recommendations accordingly, and the patient is expected to comply. The imbalance between physician and patient is not as pronounced as it is in the active-passive model, but the patient is still expected to comply with “doctor’s orders” with few to no objections.

Mutual participation model

This model is based on an equal partnership between the doctor and the patient. The doctor views the patient as an expert in their life experiences and goals, making patient involvement essential for designing treatment. The physician’s role is to help the patients determine what their goals are and how they can achieve those goals. In this model, both parties have equal power, are mutually interdependent, and engage in activities that are equally satisfying to both of them. 

While each of these models may be appropriate in specific situations, over the last several decades, there has been increasing support for doctors to use the mutual participation model whenever it is medically feasible.

Barriers to a strong doctor-patient relationship

Wellness requires collaboration. By earning a patient’s trust and respecting a patient’s autonomy, clinicians can boost patient satisfaction and master the doctor-patient relationship. The barriers to productive cooperation lie in the mindsets of both doctors and patients. Here are the main barriers to optimizing the doctor-patient relationship:

Implicit bias

Research published by The American Psychological Association (APA) examines how implicit bias affects the dynamics of a physician-patient relationship, subsequent care, and the patient’s health. Studies have shown that many healthcare providers hold some level of implicit bias toward various racial and ethnic patient groups when it comes to managing particular diseases like cancer and diabetes. Patient interaction can become stilted and unauthentic when this is the case. Continuity of care suffers when patients are forced to try numerous clinicians before finding one who makes them feel comfortable.

A physician-patient relationship in which the provider holds implicit bias and the patient distrusts the medical system due to prior discriminatory experiences leads to low-quality interactions and outcomes. The Journal of the American Medical Association cites an Institute of Medicine (IoM) report that both explicit and implicit biases are partially to blame for the fact that racial and ethnic minorities receive worse healthcare than non-minorities — even after access-to-care barriers such as insurance and family income are controlled for. On-going research and education are making progress toward healthcare equality and a higher standard of medical ethics.

Detachment

Doctors often specialize in manipulating manifestations of a disease — not as much in caring for the whole person who has the disease as well as their quality of life. Thanks to a wealth of studies, healthcare providers are shifting their perspective: instead of targeting a specific condition, organ, or biological system, they’re learning that optimal medical care enhances a patient’s health and wellbeing holistically. Whether they’re general practitioners, internal medicine specialists, or psychiatry experts, clinicians who take the time to promote good communication optimize the continuity of care required to enhance patients’ quality of life.

As The Review of Ophthalmology puts it: “We want to have a beneficial effect, and a change in a metric ‘proves’ that we did. Having a beneficial effect is what we’re being paid for.” However, how beneficial is that effect for each individual patient?

Removing a cataract, for example, may improve the patient’s vision from 20/80 to 20/20 — but the patient could end up with increased glare, which may be more important to their quality of life than improved acuity. Despite achieving a standard metric that’s supposed to “prove” a benefit, cataract surgery can change a patient’s vision in a way that decreases their quality of life. An ophthalmologist who treats the whole person and who’s versed in doctor-patient communication will learn and consider all of a patient’s needs and lifestyle preferences before scheduling surgery or other treatment options.

Patient distrust of the medical profession

Medical Economics reports that the doctor-patient relationship has been eroding for years. People are losing trust in the healthcare system, causing more than a drop in physicians’ status. Patients who don’t trust a doctor tend not to comply with that doctor’s treatment plans, leading to abrasive exchanges, clinician burnout, and less-than-ideal health outcomes.

Conflicts over the Affordable Care Act, proposals to cut Medicare and Medicaid, and the push for universal coverage have all made the healthcare professionals, health systems, insurers, professional organizations, and the current state of healthcare itself more controversial.

The internet has enabled people to do their own research and investigate their healthcare providers’ medical education. Healthcare professionals are more often chosen because they’re aligned with patients’ values and collaborate respectfully in the decision-making required to craft holistic treatment plans. Patients who want to research and discuss treatment options instead of deferring to physicians without question, however, are not always welcomed — and thus lose trust in their provider.

The doctor-patient relationship can also suffer when clinicians have to deliver the news that an insurer has declined to pay for a procedure or increased the co-pay. The doctor-patient relationship can’t improve unless trust is built on both sides.

Time

Time is a scarce resource in a healthcare professional’s practice. The National Library of Medicine (NLM) found that patients arrive at an appointment with many topics to discuss, but are only allowed a few minutes for each. Doctors’ rigid schedules don’t provide sufficient time for patients with multiple issues.

The NLM reports that patient interaction doesn’t always promote well-being. Doctors tend to talk less about topics that the patient initiates — suggesting that they don’t consider those topics as important and disregard a patient’s autonomy and attempts at medical education. Doctors also tend to talk much less with patients who show nonverbal signs of depression or anxiety — the very patients who most need interaction and compassion. This understanding should not be exclusive to psychiatry specialists.

Medical education is not enough — communication skills and medical ethics training could help healthcare professionals improve patient satisfaction. Optimizing quality of care and the doctor-patient relationship will require managing this constant time pressure and the financial incentives driving it in every medical practice.

Patient’s health literacy

The Institute of Medicine defines health literacy as “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.”

The Institute reports that enabling healthcare providers to recognize low health literacy can help them customize medical knowledge resources and tap the health services that support those with lower health literacy. Addressing health literacy barriers to preventive care may help reduce some of the disparities in health-related quality of life (HRQoL) and improve health outcomes.

Patient’s activation

BMC Family Practice researchers found convincing evidence that patients who pursue some medical education and engage in self-care generally have better health outcomes and a higher quality of life. These findings suggest that patient activation measurement can help healthcare professionals categorize patients’ values according to perceived disease management needs. The study identified three types of self-management:

  • Medical care: taking medication, complying with exercise or dietary care plans
  • Role wellness: adapting routines and rituals to create new behaviors or life roles
  • Emotional care: managing the emotional turmoil around chronic disease consequences

The better healthcare professionals get at supporting and guiding patient activation and promoting wellbeing, the better the doctor-patient relationship and health outcomes will become.

Types of doctor-patient relationships

Ultimately, the goal of the doctor-patient relationship is to improve patient care and health outcomes. But what is the ideal doctor-patient relationship? That question has been debated since the advent of the medical profession and medical ethics.

Medical News describes the four models for the physician-patient relationship proposed by Ezekiel and Linda Emanuel in 1992. They differ based on perceptions about the goal of doctor-patient interactions, the doctor’s obligations, as well as the patient’s values and the patient’s autonomy.

Informative

The informative model is also called the consumer model. It defines healthcare providers as competent technical experts who relay medical knowledge and treatment options, then wait for the patient to decide before implementing the selected intervention. Ultimately, the patient does the decision making and healthcare professionals implement and fortify with all of the medical knowledge they’ve acquired. Doctors must take control of the technical treatment plans once the patient has approved them. This model promotes today’s most popular healthcare model: patient-centered care.

Interpretive

In this model, the healthcare professional plays the role of a counselor or advisor. By explaining conditions and interpreting the medical knowledge and patient values, this type of healthcare professional helps the patient decide on and give consent for a treatment plan. This model requires that healthcare professionals have a keen sense of empathy and self-awareness.

Deliberative

This model views the healthcare professional as a friend or teacher who is open to revision of treatment plans after discussing a patient’s values and morals. A deliberative healthcare provider articulates the dysfunctions, then presents the treatment plans that best fit patient values. These types of healthcare professionals don’t implement treatment until the patient understands and gives consent for them. This requires earning a patient’s trust and developing a strong doctor-patient relationship.

Paternalistic

This model views the healthcare professionals as guardians of medical information who promote the patient’s health without the need for consent. The doctor dominates the patient interaction. The patient complies with treatment plans without questioning, researching, or evaluating the medical information provided. This autocratic model is usually leveraged in emergencies when obtaining consent may alter the patient’s well-being or when it is impossible to obtain.

These types of healthcare professionals assent to objective values, not subjective patient needs, which makes earning a patient’s trust unnecessary. This model does not respect a patient’s autonomy, inspire a patient’s trust, or promote an optimal doctor-patient relationship.

What factors can adversely impact the doctor-patient relationship?

On the other hand, a weak doctor-patient relationship, which occurs when a patient feels unheard, disrespected, or otherwise out of step with their doctor, can: 

  • Negatively affect patient care 
  • Lead to poor patient outcomes
  • Increase levels of anxiety 
  • Impede patients’ ability to understand medical information

How to improve doctor-patient relationships

After much observation and research, Medical News has published these recommendations for healthcare professionals working to improve their doctor-patient relationships:

1. Improve your communication skills for a better doctor-patient relationship.

Studies continually demonstrate that good communication improves patients’ compliance as well as medical, functional, and emotional conditions while enhancing patients’ values and attitudes about healthcare and well-being. It gradually leads to healthy doctor-patient relationships while reducing the risk of medical misconduct due to lagging medical ethics.

2. Develop empathy for a better doctor-patient relationship.

Empathizing enables healthcare professionals to understand how their patients experience symptoms and interpret well-being. Studies show that healthcare providers’ empathy has a therapeutic effect on care delivery, improves the doctor-patient relationship, and enhances the patient’s quality of life.

3. Forge trust for a better doctor-patient relationship.

A healthcare provider that doesn’t have a patient’s trust can’t inspire that patient to openly discuss health issues and ideas about their well-being. By winning their patients’ trust, healthcare professionals can improve the doctor-patient relationship, then motivate patients to comply with treatment plans to achieve better health outcomes.

4. Get patients’ informed consent for a better doctor-patient relationship.

Respecting a patient’s autonomy — both morally and legally — is critical to improving the doctor-patient relationship. The healthcare professional should be completely honest with the patients and patients’ families when providing assessments and recommending treatment plans. They should openly discuss favorable and unfavorable health outcomes and the probabilities of all treatment options on the table before getting consent to implement one that aligns with patient values.

5. Maintain professional boundaries for a better doctor-patient relationship.

Healthcare providers should never transgress the boundaries of the professional doctor-patient relationship as it disrupts a patient’s autonomy and wellness. To avoid losing a patient’s trust, they should never observe patients in unorthodox settings at their own convenience or share personal information during exams — only medical information that pertains to a patient’s wellbeing.

Patients, on the other hand, should not call too frequently, make unscheduled visits, or assume that medical school guarantees their healthcare professional will immediately have all the answers. They should understand that each body is different and that they may have to try multiple treatment options before finding the one that restores their well-being.

Leveraging telehealth in doctor-patient relationships

All of these recommendations are much easier to implement once your care team has refined its patient interaction workflow and improved continuity of care with these Welkin telehealth features:

Team-first telehealth care delivery

Welkin is an extremely flexible Care Management platform built with the medical knowledge that every care team manages patient relationships differently and needs different automated procedures to lighten workloads and increase telehealth efficiency to promote patient wellness.

Unlike EHRs, which put the primary focus on major medical events, Welkin is customizable, allowing care teams to share medical information and practice telehealth by enjoying good communication with those who have the most pressing needs. The Welkin Care Management platform can either supplement your existing systems or provide you with a one-stop platform that manages all of your doctor-patient communication and treatment plans.

Intelligent workflows

Your healthcare providers’ days will flow much more efficiently and their continuity of care will improve when Welkin’s telehealth platform guides them smoothly through medical information in these stages:

  1. Identification: qualify and enroll your patient in a program
  2. Assessment: define problems, risk, and goals
  3. Enrollment: enroll your patient in the program they’re best-suited for
  4. Care delivery: nurture your patient through the care plan
  5. Course correction: identify gaps; keep your patient on track with continuous communication
  6. Conclusion or maintenance: evaluate outcome analytics, discover trends, and schedule maintenance

Centralized telehealth communication

Successfully managing treatment plans and promoting good communication takes frequent check-ins through a variety of modalities. These omnichannel capabilities built into Welkin will support healthcare professionals’ efforts and ensure that they’ll never miss a message: HIPAA-compliant email, Zoom-based telehealth, a connected phone tree, SMS text messaging, a chat app, and fax service.

Telehealth integrations

Welkin allows healthcare providers to create software that improves doctor-patient communication now and integrate these built-in features as they grow:

  • HIPAA-compliant Zoom-based telehealth services
  • Medi-Span to validate patient medication
  • DrFirst for electronic drug prescribing
  • Codified reference data to support billing
  • Sisense-enabled dashboards and reports on treatment plans
  • Calendar syncing for efficient scheduling
  • DocuSign to allow patients to sign secure documents electronically

High-security telehealth

Welkin helps healthcare professionals earn a patient’s trust by protecting their data integrity when sharing medical information with care team members using flexible role-based, attribute-based, and territory-based security permissions. They can also use our time-stamped audit trail to track who changed user levels at what location and at what time. For added security, your team can choose either single sign-on (SSO) or multi-factor authentication (MFA).

With the help of leading third-party security organizations like Service Organizational Controls (SOC), we’ve implemented a number of technical, administrative, and physical safeguards designed to protect your confidential data. Welkin enables anyone subject to HIPAA to process, maintain, and store medical information in a secure environment to solidify each patient’s trust.

What is patient satisfaction and why is it important? 

Patient satisfaction refers to the extent to which patients are happy with their healthcare, both inside and outside of the doctor’s office. When the four pillars of the doctor-patient relationship are strong, patients tend to be pleased with their healthcare.

Happier patients also tend to be more compliant, leading to better health outcomes — a win-win for patients and healthcare providers. Decades of research demonstrate the importance of patient satisfaction. Consider the following: 

Ready to master your doctor-patient relationship?

Now that you understand the importance of improving your doctor-patient relationships for the sake of patient satisfaction, your own professional satisfaction, and your bottom line, encourage your entire team of healthcare providers to make it a priority by using patient-centered telehealth tools that enhance the well-being of both patients and clinicians. Download our patient-centered care checklist.

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