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The Physician - Patient Relationship Physicians who carefully listen to patients and comfortably share medical information with them have discovered the cornerstone of the art of medicine. A healthy physician-patient relationship can make a difficult diagnosis more bearable for the patient. It can help a resistant patient understand the need for a procedure or medication, and allow the physician to develop a realistic plan for continuing care. When a physician's relationship with a patient is marked by mutual trust and open communication, he or she has taken a major step towards the assurance of patient satisfaction. Evidence shows that a clear, two-way conversation is a key element in the prevention of patient dissatisfaction and malpractice claims. In fact, many episodes of patient dissatisfaction triggered by an iatrogenic injury or other "adverse outcome" can be defused by a reasonable explanation from the physician who has established a good basis for communication. On the other hand, inadequate communication and misunderstanding are often the inciting agent that transform a poor medical outcome into a legal action against a physician, even when quality care was delivered. Most studies show that a significant percentage of malpractice lawsuits are ultimately resolved without any payment to the patient. Many risk managers believe that a large number of these malpractice cases could be avoided if physicians listened more attentively to patients who experienced less than optimal or unexpected treatment outcomes. Techniques for increasing patient satisfaction through improved communication are now widely recommended for malpractice claims prevention.   Recommendations for a Healthy Physician - Patient Relationship Risk management begins the moment a professional relationship is established with a patient. The understanding by, compliance by and satisfaction of any patient ultimately depend on oral and written communication. The following general points will be helpful as you build each physician-patient relationship. The result should be a mutually rewarding experience for both the physician and patient. Introduce yourself to every new patient and describe your relationship with other health care providers, such as students, nurses, physician assistants, residents, fellows, consultants, and the relevant attending, referring and primary care physicians. Address your patients appropriately and modify your greeting as your relationship progresses. It is best to begin with formal titles; then, if both sides are comfortable with doing so, shift to something less formal. If possible, use a translator to help communicate with patients who speak a foreign language with which you are unfamiliar. Sit down close to the bedside, if possible, and make frequent eye contact. Be attentive to the patient's non-verbal communication. Offer your own encouraging feedback through gestures and words. Begin with open-ended questions to allow patients to talk of their symptoms, previous care, impressions of their prognosis, and the role of family members in decision making. Focus questioning to obtain specific information. Ask for the patient's expectations of your care. Involve the patient and family (if the patient so desires) directly in the care as much as possible. Limit the use of medical jargon. Relate information at an appropriate level of understanding for the patient. Use pictures and models to help explain complicated concepts. Provide emotional support to grieving, anxious, frightened, or depressed patients. Reassure your patients that you will be helping them throughout the course of their medical problems and will be available to answer questions as they arise. Be punctual for meetings with patients and families. Avoid criticizing another physician's management of your patient with words or gestures. The other physician may have had different data and resources available at the time of initial decision making. Medical problems usually appear more clearly when viewed retrospectively. Malpractice cases have often been precipitated by criticism of this kind and you may find yourself an expert witness based on your comments. Never guarantee the outcome of a treatment, orally or in writing. Prepare patients for any pain, discomfort, and disability that they can reasonably expect from diagnostic and therapeutic interventions. Make clear the necessity and effectiveness of intervention if disability is the expected result. Document these discussions. arise. Send a written summary of your findings and the medical plan to your patient's primary physician following a hospital stay or major office visit. When multiple clinicians are involved, clearly delineate roles among the parties and convey this to the patient in a manner that will facilitate coordination of patient care. When it is necessary to discuss fees, be open and frank concerning the cost of care. Where appropriate, help educate patients concerning today's often confusing health care system. You might consider providing an estimate of the cost of an anticipated course of therapy or operation. However, be careful not to make representations of the prospective cost of hospitalization or other services not within your control. Be aware of the state and federal laws regarding health care law for your patient population. Information on childhood vaccinations, prenatal nutrition programs, Medicare benefits, and other topics are vital for proper care of your patient. Be sure your office staff and answering service treats the patient with courtesy and consideration.   Frequently Asked Questions About The Physician - Patient Relationship Question: When a patient is difficult, non-compliant or otherwise incompatible, and a physician believes that he or she cannot continue to provide care within these constraints, what is the best way to go about terminating the physician-patient relationship? Answer: The instances of the patient's non-compliance and difficult or disruptive behavior should have been noted contemporaneously with their occurrence in the patient's medical record. Once a physician has made the decision that the relationship will be terminated, the reasons for the decision should also be noted in the medical recor\. Always attempt to meet with or speak with the patient (and family members, if appropriate) to inform them of your decision, explain the reasons for it, and to answer any questions the patient may have. It is recommended that you notify the patient in writing, both by certified and regular mail, of your decision and the specific professional reasons for terminating the relationship. This should be done even if you have met with the patient. The following should be included in the letter: Offer to continue treatment for at least 30 days (or for a period of time appropriate for the status of the patient's medical condition), until the patient retains another physician. Offer to provide information to assist the patient in selecting a new physician to assume their care. You may also offer to or actually provide the names of several physicians or clinics to help the patient in selecting a new physician. Advise the patient of a specific date when you will consider the relationship terminated. Offer to provide the new physician with copies of the patient's medical records upon the request of the patient. If one of the issues with the patient involves the failure to follow directions or advice, it is useful to describe the medical problem, the recommendations and the degree of urgency involved. Since the circumstances involved with each patient are unique, you may wish to contact the Office of Legal Affairs for specific advice. Question: If the patient has not paid my bill for professional services, may I terminate the relationship? Answer: Yes. Use the principles noted above for notifying the patient. However, the law does not permit the refusal to forward medical records even though a bill has not been paid.