ARTICLE
Patients need to feel like you're their ally. It is well known that a doctor's demeanor influences the clinical response that patients have to any treatment. Careful listening, examination, and reassurance can decrease patients' suffering in the broadest sense of the word. This has been the bread and butter of counselors for years. People will faithfully attend and pay for therapy visits just to have an attentive and active listener and to feel like they have an ally. Data also shows that adherence to treatment plans is dependent on how patients feel about their provider. Primary care is a relationship-based business. You have to "earn" the right to offer help to the individual and gain their trust. “Titles" and specialty accouterments give us a foot in the door, but they don't usually get us all the way into people's inner circles of trusted advisers. In the age of corporate medicine, there is a belief that patients attach themselves to institutions and networks because of their trust in the organizations. That may be a factor when someone is looking for sophisticated specialty interventions, often one-time-only, e.g. "where's the best place to go for high-risk cardiac surgery.” But when looking for primary care, people still tend to ask, "who's a good doctor." How do you, as a clinician in today's restless and mobile society, earn trust and build therapeutic relationships in short visits, often with the insurance company determining the course of treatment? The first three steps are as simple as ABC: Attention: pay attention to the individual that is in front of you and seeking your attention. Behavior: behave like the professional that the individual expects. Are you “the good doctor” that they seek? Behave like a “good doctor." Connection: make a personal connection with the individual that is seeking your attention. Find out what they are interested in. Share your interests in such a manner that there is a commonality between you, at least for the visit. But where do you go from there, how do you continue, grow, and nurture a therapeutic relationship over time? 1. Listen and respond. If you hear something that immediately requires clarification, do what you would do in a social situation. Say that what the other person just said is important or interesting, reflect back what you think you understood and then invite them to continue their story. Imagine that you're meeting an interesting person at a dinner party, not leading a legal interrogation. 2. Set an agenda. If you don't ask what people need from you, how can you ever hope to fill your role as their provider? Patients may not reveal their real concerns when making an appointment, and their priorities may have changed since then. Going all-in with what you think is their main issue may be a recipe for wasting time. Agenda-setting needs to be addressed early, or after hearing a little about the main concern. 3. Budget time. Invest your time and attention on listening and understanding early on in the visit. By acting unhurried at first, you are more likely to create an atmosphere of trust and caring; once you know your patient's concern and formulate a diagnosis, if they feel heard, you can move to wrap up the visit if necessary. 4. Manage the perception of time. If running late, enter the exam room and demonstrably sit down, take a deep breath, and relax your posture as if finally arriving at the most important appointment of the day. That slowing down gesture helps to undo fear that they will be rushed. If they think you are too rushed to meet their needs, their memory of the visit will likely be just that, even if their clinic needs are technically met. 5. Don't be a hero. Everyone is on their own journey in life, and we are at best guides in our patients’ pursuits. As guides instead of heroes, remind yourself that we are not the ultimate experts on what is best for our patients. Since our patients are the heroes of their own stories, they must ultimately decide which piece of advice from which guide they will choose to follow. 6. Be true to yourself. We must adapt our demeanor to the situation – reassuring, motivating, inquisitive, or sometimes decisive – but we must stay within the range of our real selves. For example, some can be jovial only to a point before they will seem and feel pretentious, People can usually sense such falsehood. 7. Balanced disclosure. We must engage as real people, and you can't be real without showing emotion, genuine interest, engagement, and a good amount of humility. We have to be careful to show that we are fallible like everybody else but also that we ultimately have our act together. Nobody wants a self-absorbed, overconfident guide, but nobody wants a weak and insecure one either. 8. Build continuity. From one visit to the next, find a thread to follow. Reconnecting about what you talked about last time is a powerful and quick way to reestablish the fact that you know each other and that you care about your patient. It brings you straight into a space where you are ready to do the work you do. That quick reconnection that begins every visit helps make you seem better prepared; maybe you don't remember the details of the last visit, but you do remember your patient very well. 9. Solicit participation. When it's time to formulate a treatment plan, don't be too quick to lay it out as if there is only one way to do things. Invite the patient to participate in your plan for guiding them to achieve their objective. Seek their feedback and work to guide them to the best solution that meets their needs. 10. Plan when and how to reconnect. Friends don't usually leave each other saying, "I'll see you around," that's more for casual acquaintances. "Follow-up PRN" isn't usually the best way to conclude a visit. It's important to agree on when to meet up if everything is, or is not, going well. Not making such plans devalues the relationship and makes you look as if you don't care about your patient. Trust can be easy to loose, but consistent attention to building it will go a long way to helping others to trust you more. Source: https://www.medpagetoday.com/blogs/kevinmd/84739