The relationship between physicians and patients is a fiduciary relationship. Fiduciary relationship is a relationship based on trust. In such a relationship, there should be confidentiality between the two parties: the physician and the patient.
Therefore, physician – patient relationship refers to the interaction between the patient and the health care professional in which interpersonal communication, compliance, satisfaction and trust are established. The physician – patient relationship is a central part of health care and practice of medicine. Having good communication skills is essential for physicians to establish good physician – patient relationship. This is in the sense that, good communication skills lead to good physician – patient relationship with which there are benefits and challenges which need to be tackled.
Good physician – patient relationship improves health, functional and emotional status of patients. Good physician – patient relationship has been shown to have positive effects on health. Some patient do not need or not all patients need medications to cure their diseases. Thus, having a good communication with such a patient can have a better outcome. A practical example I encountered during my first vacation practical skills was on the issue of good communication. That is, during my practice, I met this old woman at the ward, who was hypertensive. I monitored her for about two days at the ward. One day after the ward rounds, she suddenly had elevated blood pressure and I attended to her. After the intervention, her blood pressure was managed. I decided to have a conversation with her because I was not convinced that the sudden elevation in blood pressure was due to the fact that she was a known hypertensive patient but I felt that there was something wrong somewhere. I approached this patient and because I had already established a good interpersonal relationship with this patient, she genuinely told me whatever the problem was and this confirmed my suspicion that the elevation in blood pressure was psychological. This patient had other issues she was thinking about and was bitterly worried about. I communicated with this patient and was able to take her through some education and reassured her of things coming back to normal if she stopped thinking and worrying about those issues. Based on the communication I had with this patient, she was able to prevent recurrent elevation in blood pressure having in mind that things will be okay if she stop thinking and worrying about such issues. In fact, good physician – patient relationship helps to control a lot of conditions including emotional distress, hypertension and the likes.
Compliance with medical treatment. Low compliance with prescribed medical interventions is an important problem in medical practice and it is associated with substantial medical cost including increased hospital admissions. The doctor-patient relationship may have an important role to play in this aspect. It has been shown that a doctor’s attitude towards his patients, his ability to elicit and respect the patients’ concerns, the provision of appropriate information, demonstration of empathy and the development of patient trust are the key determinants of good compliance with medical treatments in patients.
Improved patient satisfaction. This deals with explaining or communicating to the patient about their health conditions and how best they can be solved or managed. Counselling and educating patients about their disease conditions help to improve recovery. This increases the satisfactory state of the patient because it makes the patients aware of his or her condition and how to manage it. On the other hand, expectations and trust of patients for physicians are also increased.
Aside the benefits of good physician – patient communication, its challenges are not to be over looked. A challenge is that, it becomes a problem when the physician and the patient are not on the same field of language. This is to say that a patient does not understand the language of the physician or a physician does not understand the patient’s language. What happens when this occurs? The commonest solution to this question is the involvement of a third party which reduces the accuracy of the information in one way or the other. The third party either omits some of the information or adds something to the information. Pertaining to this challenge, I equally encountered a patient during my practical skills on vacation. We had a patient who could not speak any language apart from French. The history of this patient had to be taken from a relative. It got to a point where we had to skip or pass by this patient during ward rounds just because the relative was not around to interpret the information for us in order to get the patient’s history. This led to slow treatment therapy and poor history taking.
Another challenge is when patients are not given the chance to express or lodge their complaints. Even though good physician – patient communication is ongoing, some health professionals also doing otherwise. Thus, some patients are not given the opportunity to express their complaints. In other settings too, even the first approach by some health professionals pose some kind of fear to patients which prevent patients from giving the exact reason why they came to their facility. This results in poor history taking and eventually poor diagnosis. Thus, good history taking is one of the keys in giving good diagnosis. Making a patient uncomfortable by your appearance and questions will not let you achieve your goal as a health professional.
Breaking or disclosure of confidentiality where not necessary is another challenge which needs to be addressed. Why am I saying so? This is because as health professionals, we take the Hippocratic Oaths which we have to abide by. The oaths emphasizes confidentiality. What do we see nowadays? We have reached an era where health professionals disclose confidentiality of their patient at the wrong time. We do this by discussing issues of our patients with our friends and even our family members at home. We also end up taking pictures of our patients and circulating them all over social media. And most of these are done without the consent of patients. Now, how many times does bank managers discuss the amount of money a client deposited or withdrew from the bank with his friends? But this is common among health professionals.
In conclusion, I say that good physician – patient relationship benefits both the physician and the patient which includes functional and emotional status of patients, compliance with medical treatment and improved patient satisfaction. Also not forgetting the challenges that come along with this which need to be tackled. Thus, when the physician and patient are not on the same field of language, when the patients are not given the chance to express or lodge their complaints and the breaking or disclosure of confidentiality where not necessary.
I suggest or recommend that, these challenges can be minimized and eventually eradicated at the end. Some of the measures that can be put in place are that, health professionals need to learn different languages or competent people need to be trained for interpretation of information between patient and physicians who are not on the same field of language, health professionals need to revisit the Hippocratic Oaths and abide by it or confidentiality needs to be broken only for therapeutic purposes and finally patients should not be intimidated by any health professional because patients need express their feelings or complaints. This is their right and it has to be respected. (Patient autonomy)
By Sulleyman Adams
The writer is a physician at the University of Cape Coast
Email: [email protected]