Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

You can’t legislate doctor-patient relationships

J. Russell Strader, MD
Physician
December 8, 2013
Share
Tweet
Share

I was on call this past weekend, rounding at about 8am on the cardiology floors, and a woman I didn’t recognize approached me.  She asked if I remembered who she was, and was quick to tell me that if I didn’t it was ok.   She had had bariatric surgery about 6 months previously, and I had seen her in the office for a pre-surgical consultation.

She went on to tell me that she had lost 80 pounds since her surgery. She no longer had diabetes, and was no longer on high-blood pressure medication.  Her cholesterol levels had fallen in half, and she was now exercising every day.

And then she did something unexpected:  she thanked me for talking to her when she had her office visit with me six months earlier.  It turns out she was initially very hesitant to have the procedure done.  She didn’t want to go through all the “hoops” that her doctors, and insurance company, required prior to having the surgery (by the way, a visit with a cardiologist to ensure that her heart was healthy enough to have the surgery was one of the hoops).

But we sat and visited, and although I don’t remember the conversation at all, she told me that my taking five minutes to talk with her — instead of clicking boxes on the computer, or instead of rushing her out the door — made all the difference, and guided her towards what she needed to do to take care of her health.

There are a multiple different lessons from this anecdote.   Among the most important is the knowledge that what we as physicians say and do, and how we say it and do it, matters.  It’s not just the medical knowledge, although sharing with her the benefits to her health over the long term of controlling her weight, diabetes, hypertension and hyperlipidemia did influence her decision.   But it’s the manner in which information is conveyed, and the place, and the timing.  It’s little things like turning away from the computer and looking someone in the eye when talking with them.  It’s treating people with respect, courtesy, and as equals, not as yet another number to move through the office.

I think about how our “health care system” is trying to rearrange itself, and wonder what will happen to encounters like this.  Most physicians enter the field of medicine because it gives us a chance to give back to others what we all have most likely been given at some point along the way.   And although the current checklist paradigm of making sure that the basic things are done right (e.g. treating blood pressure and diabetes to appropriate targets to minimize risk of future adverse events) helps us as physicians focus our efforts onto prevention and disease management, our method of doing so matters.

Would a web-based form or a self-assessment tool or a phone call to a nameless person hundreds of miles away had the same effect for this patient as our face-to-face encounter did?   If I had simply clicked my through the required boxes on my EMR template (which are required not by me, but by Medicare, so that I could get paid for the time I spent with her), would the outcome have been the same?  She was reassured precisely because I wasn’t a provider or communicator or technician or a computer entry specialist, but rather a doctor, a physician, and because I took five minutes to act like one.

Ultimately medicine is about people and about relationships.  You can’t legislate relationships.   You can’t put a price on it.  You can’t figure out how to reimburse it or how much each minute of that relationship is worth.  It’s hard to imagine that if we could do a better job on our end, and that if they — the payors and regulators and legislators – would let us and require less administrative work, that the end result wouldn’t be the type of health care system that we all are hoping to achieve.

J. Russell Strader is chief, cardiovascular services, the Medical Center of Plano.

Prev

Is deep learning in medical education possible?

December 8, 2013 Kevin 4
…
Next

Direct pay primary care and the ACA still don't mix

December 9, 2013 Kevin 36
…

Tagged as: Cardiology, Diabetes, Endocrinology

Post navigation

< Previous Post
Is deep learning in medical education possible?
Next Post >
Direct pay primary care and the ACA still don't mix

ADVERTISEMENT

More by J. Russell Strader, MD

  • a desk with keyboard and ipad with the kevinmd logo

    The true service your doctor is providing is thinking

    J. Russell Strader, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Why graduate medical education is failing

    J. Russell Strader, MD
  • a desk with keyboard and ipad with the kevinmd logo

    We really need 3 health care systems

    J. Russell Strader, MD

More in Physician

  • The unseen burden patients carry between appointments

    Ryan Nadelson, MD
  • My journey to loving primary care again

    Jerina Gani, MD, MPH
  • Why doctors striking may be the most ethical choice

    Patrick Hudson, MD
  • How photos shape drug stigma—and what we can do about it

    Jeffrey Hom, MD, MPH, MSHP
  • From participants to partners: Rethinking clinical trial design

    Robert Den, MD
  • First-name familiarity improves doctor-patient connection

    Ryan Nadelson, MD
  • Most Popular

  • Past Week

    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
    • How AI, animals, and ecosystems reveal a new kind of intelligence

      Fateh Entabi, MD | Tech
    • Why kratom addiction is the next public health crisis

      Muhamad Aly Rifai, MD | Meds
    • A physician employment agreement term that often tricks physicians

      Dennis Hursh, Esq | Finance
    • The hidden moral injury behind value-based health care

      Jonathan Bushman, DO | Physician
    • Nurse-initiated protocols for sepsis: a strategic imperative for patient care and hospital operations

      Rhonda Collins, DNP, RN | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Affordable postpartum hemorrhage solutions every OB/GYN should know

      Frank I. Jackson, DO | Conditions
    • Why kratom addiction is the next public health crisis

      Muhamad Aly Rifai, MD | Meds
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
    • How are prostate exams done and why you shouldn’t avoid them

      Martina Ambardjieva, MD, PhD | Conditions
    • Airlines’ policy ignores your do not resuscitate (DNR): Discover why and some ways to protect yourself

      Althea Halchuck, EJD | Conditions
    • A dual citizen’s choice between two imperfect systems [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 2 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
    • How AI, animals, and ecosystems reveal a new kind of intelligence

      Fateh Entabi, MD | Tech
    • Why kratom addiction is the next public health crisis

      Muhamad Aly Rifai, MD | Meds
    • A physician employment agreement term that often tricks physicians

      Dennis Hursh, Esq | Finance
    • The hidden moral injury behind value-based health care

      Jonathan Bushman, DO | Physician
    • Nurse-initiated protocols for sepsis: a strategic imperative for patient care and hospital operations

      Rhonda Collins, DNP, RN | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Affordable postpartum hemorrhage solutions every OB/GYN should know

      Frank I. Jackson, DO | Conditions
    • Why kratom addiction is the next public health crisis

      Muhamad Aly Rifai, MD | Meds
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
    • How are prostate exams done and why you shouldn’t avoid them

      Martina Ambardjieva, MD, PhD | Conditions
    • Airlines’ policy ignores your do not resuscitate (DNR): Discover why and some ways to protect yourself

      Althea Halchuck, EJD | Conditions
    • A dual citizen’s choice between two imperfect systems [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

You can’t legislate doctor-patient relationships
2 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...