An excerpt from The Game Plan: A Woman’s Guide to Becoming a Doctor and Living a Life in Medicine.

Relationships are complicated for many women and can have an even greater complexity for the female physician whose life and time is scheduled for upwards of a decade during medical school and residency. When planning to spend time with any loved one, the answer to the questions who, what, when, where, and how are not always easy to figure out. Though these relationships could become strained with the stress of a career in medicine, your relationships with family, friends, and your significant other will likely be your saving grace while in medical school and beyond. Don’t table your relationships. Start developing these relationships early and continue to nurture them.

Sylvia: Constance Miller, Capitol Hill staffer for Congresswoman Maxine Waters, was a mentor who helped me navigate the politics of organizations. She was great at seeing the long game and asking the right questions that spurred me to think about an opportunity. She helped me not to be afraid to change jobs or cities in search of a new opportunity. A consummate cheerleader, she provided tough, poignant advice based on a life well lived. Constance went from mentor to friend to aunt. During my moves across country and breakups, Constance was always a phone call away. Constance sent me cookies during residency and innumerable cards for holidays, birthdays, and encouragement.

Patients

Most people who choose to go into medicine do so with the desire to help people. As aspiring health care providers, we want to help people and have great patient relations. Depending on your specialty, the patient relations will differ. For example, a pathologist will have little to no relationship with patients, whereas primary care physicians may have long standing patient relationships over decades. You can learn about the family, friends, birth, and deaths during the course of the relationship.

Diane: As an OB/GYN, I have many long-term relationships with patients. Countless numbers of newborn photos hang in my office. One of the rewarding parts of my job is to receive those thank you notes from patients. When they let me know that I really helped them or that they never had someone explain things to them the way that I do, I know that I have done my job for the day. Years ago, I started saving thank you cards from patients. I use them for inspiration when I get down and lose my way in medicine.

With all the good, there are sometimes bad patient relationships that you have to deal with. There are some people that will not be satisfied no matter what you do.

Angela and Diane: We always tell patients that if we can’t address their concerns, there might be another physician that can connect and explain things in a way that is better. Or at times, we encourage patients to obtain second opinions for medical advice that they have sought from us. Not that we didn’t understand the concern, but sometimes it is necessary for a patient to hear their concerns answered in a different way. At the end of the day, the role of the physician should be a facilitator of a good patient relationship.

The doctor-patient relationship is evolving. In the past, many patients took the doctor at their word for their expertise. Many patients are now turning to the internet, social media, and other avenues to obtain medical advice before even seeing the doctor. Patients are now considered customers and not patients, and when they do not get what they want, they may choose to go elsewhere. Balancing their needs, wants, and expectations can be draining. This can lead to a strained relationship when a patient demands certain options that they read about that you feel are not medically appropriate. Finding ways to keep the patient engaged while expressing your medical opinion is a fine line that must be carefully walked. To the dismay of many in the medical field, patient satisfaction has become inbred in the field of medicine. While we work hard to give the best medical care in a way to make patients feel better, there are times where the satisfaction of the patient does not align with appropriate medical care. Sometimes you just cut your losses and continue to practice the most evidenced-based medicine in a manner consistent with your principles.

Jessica: Online reviews can negatively impact the doctor-patient relationship. The evaluation of the encounter is one-sided because the physician’s perspective is not included.

Angela: I have found that taking the time to listen to even the most outrageous request or complaint may be all that the patient needs. Patients want to be heard; however they often do not understand the time constraints of a busy physician’s schedule.

Sylvia: Even when another patient asks about putting yogurt into her vagina to treat yeast infections…

Jessica: Scheduling patients is like dating. You never know what you are going to get. It may take 15 minutes or an hour depending upon how sick the patient is.

Sylvia: Patients hear things that are not always said. Asking the patient to repeat what you have said and then leaving time to answer questions can help clarify things, Like when I say, “You have a mass,” and they hear, “I have cancer, and I am dying.” I follow up and make sure they hear me say, “A mass is often benign. We’ll need additional studies to have an accurate diagnosis.”

Being able to effectively communicate with patients is a must. You can be the most brilliant-minded physician in your area of expertise. However, if you are unable to engage a patient in a way that makes them feel comfortable enough to listen, ask questions, and take your advice, all the book knowledge will not be of benefit for your patients.

Angela Walker, Sylvia Morris, Diane Boykin, Leah Matthews, and Jessica Osborn are physicians and authors of The Game Plan: A Woman’s Guide to Becoming a Doctor and Living a Life in Medicine.