How does a strong doctor/patient relationship translate into better quality of care for the patient?

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How does a strong doctor/patient relationship translate into better quality of care for the patient?

A strong doctor-patient relationship can make all the difference in a patient’s treatment and quality of care. In my experience, abiding by a few key principles goes a long way in building a relationship that enables a more successful diagnostic and therapeutic regimen.

The first, and arguably most important principle for me, is to see each patient as a person rather than a patient with cancer. Making them feel comfortable that I’m concerned about their disease process and ready to get through it as a team helps build trust from the beginning.

To do so, I work to establish good communication practices. When I’m getting to know a patient for the first time, I ask questions that can’t be answered with a simple yes or no. Asking someone about where they live or how they became interested in their career helps me get a holistic view of their life and the details that come out of these conversations allow for personalized and specific care.

Caregivers are also incredibly important to the equation. Whether their family, friends or neighbors are supporting the patient, it’s critical to create a dialogue with these people so they can answer questions and provide context in certain situations.

To build and maintain these relationships, I’ve found eye contact and an occasional physical touch to their hands reassures the patient that I’m listening and engaged in their treatment plan.

Every patient is unique and every cancer is different. Remembering that about each person that walks through my door translate to a better experience for both the patient and the doctor.

Edith Mitchell
Clinical Professor of Medicine and Medical Oncology, Thomas Jefferson University

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Edith Mitchell
Clinical Professor of Medicine and Medical Oncology, Thomas Jefferson University

Edith Peterson Mitchell, MD, is Clinical Professor of Medicine and Medical Oncology and Program Leader in Gastrointestinal Oncology at Thomas Jefferson University. In addition, she holds the positions of Associate Director of Diversity Programs for the Kimmel Cancer Center at Jefferson and Director of the Kimmel Cancer Center to Eliminate Cancer Disparities. Dr. Mitchell received a B.S. in biochemistry "with distinction" from Tennessee State University and her medical degree from the Medical College of Virginia in Richmond. In 1973, while attending medical school, Dr. Mitchell entered the Air Force and received a commission through the Health Professions Scholarship Program. She entered active duty after completion of her internship and residency in Internal Medicine at Meharry Medical College and a fellowship in Medical Oncology at Georgetown University. 

Dr. Mitchell is a Fellow of the American College of Physicians and a member of the American Medical Association, the National Medical Association, Aerospace Medical Association, Association of Military Surgeons, and the Medical Society of Eastern Pennsylvania. She also belongs to the Eastern Cooperative Oncology Group, Radiation Therapy Oncology Group, National Surgical Adjuvant Breast and Bowel Project, and the Philadelphia Society of Medicine. 

Dr. Mitchell's research in pancreatic cancer and other GI malignancies involves new drug evaluation and chemotherapy, development of new therapeutic regimens, chemoradiation strategies for combined modality therapy, patient selection criteria, and supportive care for patients with gastrointestinal cancer. Dr. Mitchell travels nationally and internationally teaching and lecturing on the treatment of gastrointestinal malignancies. 

Dr. Mitchell has authored and co-authored more than 100 articles, book chapters, and abstracts on cancer treatment, prevention, and cancer control. As a distinguished researcher, she has received 21 Cancer Research and Principal Investigator Awards, and serves on the National Cancer Institute Review Panel and the Cancer Investigations Review Committee.

In addition to her medical achievements, Dr. Mitchell is a retired Brigadier General having served as the Air National Guard Assistant to the Command Surgeon for US Transportation command and headquarters Air Mobility Command based at the Scott Air Force Base in Illinois. In this capacity she served as the senior medical Air National Guard advisor to the command surgeon and was the medical liaison between the active Air Force and the Air National Guard. Her responsibilities in this role included ensuring maximum wartime readiness and combat support capability of the worldwide patient movement and aero medical evacuation system, the Global Patient Movement Requirements Center and AMC's 52 Air National Guard medical squadrons.

General Mitchell has been awarded over fifteen military service medals and ribbons including the Legion of Merit, Meritorious Service Medal, Air Force Achievement and Commendation Medals, National Defense Service Medal, and Humanitarian Service Medal. Dr. Mitchell was selected for inclusion in America's Top Oncologists.

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How does a strong doctor/patient relationship translate into better quality of care for the patient?

The doctor /patient relationship is built on mutual respect, utmost trust, and dedication of the parties involved. This relationship allows both parties to engage in a frank and open professional interaction that best serves the patient health care needs. Such a relationship must not be affected by an outside pressure, on either side, to force a different choice of care nor be affected by any monetary gain or loss.

The proliferation of managed care, Medicare advantage plans, hospital ownership of practicing physicians, and other care delivery models has weakened this special relationship. From withholding or delaying care to increase year-end bonus, to ordering more tests or unnecessary services to boost the RVUs score, the patients’ health shifted to the accounting department. Employed physicians are losing their own ties with the patients to the institution that owns the practice.

I believe the traditional doctor/patient relationship is better maintained in the private practice setting given that the doctor provides the unbiased advice but the ultimate choice belongs to the patient. 

Edmond Cabbabe
Chairman, Center for Patient Safety

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Edmond Cabbabe
Chairman, Center for Patient Safety

Dr. Edmond B. Cabbabe has been the Clinical Professor of Surgery in the Division of Plastic & Reconstructive Surgery at the St. Louis University School of Medicine since 2003. He is currently the Chairman of the Heart of America Caucus (MO, KS, OK, AR) at the American Medical Association House of Delegates and the Chair for The Center for Patient Safety (PSO) Board of Directors in Columbia, Missouri.

The recipient of numerous awards and accolades, Dr. Cabbabe is also involved in many charitable services. In St. Louis, he launched a “Stop violence before it starts” campaign, and has treated rehabilitated gang members by removing their gang-affiliated tattoos for free.

Dr. Cabbabe is from Aleppo, Syria, and received his medical degree from the Damascus University School of Medicine. He is married, and a father of three.

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How does a strong doctor/patient relationship translate into better quality of care for the patient?

A doctor-patient relationship represents a collaboration, a shared commitment by both doctor and patient to work towards a common goal of therapeutic success.  The importance of this mutual determination cannot be understated as treatment efficacy relies on both parties as neither can be successful in isolation. 

As a headache specialist, I find this message driven home to me on a daily basis.  When I work out a treatment plan with a patient, it is a conversation, not a lecture.  We determine together what is realistic for the patient – goals of care, ability to take medication, tolerance for side effects, capacity to make meaningful lifestyle changes – and craft a strategy together taking that patient’s needs and desires into account.  When the patient leaves the office, the conversation is not concluded but continues as the patient reflects upon the changes necessary to achieve the therapeutic objectives.  I find that patients take this responsibility incredibly seriously and work diligently to make those changes a reality. 

What follows is pure magic.  The patient takes the medications prescribed and notes the reaction – both positives in terms of treatment efficacy and negatives in terms of side effects.  She/he keeps track of those reactions and is able to weigh the relative benefits of the treatment.  Sometimes we’ve found the right fit and the patient reports the treatment triumph.  Other times, the medication misses the mark.  When that happens, the patient contacts me, equipped with the skills to work together to alter the treatment plan and find something better.

The same thing happens with respect to lifestyle changes.  For patients with headache syndromes, these can often be tremendously challenging.  But the patient is prepared to face the challenge because of our team approach, carefully considering what she/he can commit to before even leaving my office on the first visit.  This empowers the patient to take control over the disease, to fight back knowing that they have a cheerleader routing for them along a path to success.  Patients tell me that they hear my voice when they are on the treadmill at the gym, encouraging them to give it just another 15 minutes.  We strategize over tools that can help them, like phone apps to track their hydration or wearable technology that assess their sleep quality and consistency.  They return with abundant enthusiasm, excited to tell me of their successes.

The best quality of care is only achieved when both doctor and patient are partners in care.  By working as a team, my patients and I build a path to recovery.    

Joshua Cohen
Neurologist, Mt. Sinai Roosevelt Hospital

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Joshua Cohen
Neurologist, Mt. Sinai Roosevelt Hospital

Joshua M. Cohen, MD, MPH is Director of Education at Mount Sinai Continuum Hospitals, Director of the Headache Fellowship Program at the Headache Institute and Adolescent Headache Center, an attending neurologist at Mount Sinai Roosevelt Hospital, and an assistant professor of neurology at the Icahn School of Medicine at Mount Sinai. He is Board certified in Neurology and Headache Medicine. He is a leader in organized medicine on the national, state, and local level, currently serving as President of the New York County Medical Society and on the governing Council of the Medical Society of the State of New York (MSSNY). 

He has also worked extensively with non-profits dedicated to improving public health. Since 2013, he has served on the Board of Directors of the American Medical Association Foundation . He was a founding Board member of the Nan Lightstone Foundation whose mission is to support research and public education on infectious diseases and is former Co-chair of The Trevor Project NextGen, supporting that organization's work to provide suicide prevention and crisis intervention services to LGBTQ youth. 

Dr. Cohen completed his undergraduate training at Harvard University, medical school at the New York University School of Medicine, and his neurology residency at Columbia University's Neurological Institute. He also trained at the Columbia Mailman School of Public Health where he received his Masters of Public Health. He completed his headache fellowship at The Headache Institute and a mini-fellowship in pediatric headache at Cincinnati Children's Hospital. He is the recipient of multiple awards and accolades, including the American Headache Society (AHS)/Merck US Human Health Scholarship Award, the Arnold P. Gold Foundation Humanism and Excellence in Teaching Award, and the Harvard University Derek Bok Center Teaching Award.

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How does a strong doctor/patient relationship translate into better quality of care for the patient?

My best clinical shifts are the ones where I know that I am on the same page as my patient and I make clinical decisions incorporating principals of shared decision-making. Emergency medicine presents a unique challenge to the doctor/patient relationship. The first challenge is that patients almost never “want” to be in the emergency department (ED). They typically come reluctantly because they are in need of help for their acute medical problem. The second challenge is the ED is a chaotic environment. Most patients are overwhelmed by the sheer number of people, the beeping of loud monitors and the wait times. Finally, emergency physicians have the unique task of establishing a critical relationship with a patient who is essentially a stranger.

Within the first 30 seconds of walking into a room, I need to establish a relationship that will last beyond the confines of the four walls of the ED. Most patients go home after their ED visit and must trust my judgment and recommendations such that they take the medications I prescribe, follow the instructions I give, or make appointments with the specialists that I refer them to. All of this is in the context that our paths will unlikely cross again, and yet a good doctor/patient relationship sets these plans in place and the patient trusts me, their doctor, enough to see them through.

Shared decision-making to me is not about patients dictating care. Many providers get frustrated when patients expect that certain tests will be done or medications prescribed. When I have been in that situation, I try to get a sense of the patient’s underlying concern. It usually is not about getting a specific test or an antibiotic, although that may be what the patient asks. Usually, that is just scratching the surface and their real concern may be about an underlying disease or the way a symptom impacts their life. Shared decision-making is about understanding the patient’s unique set of circumstances and providing the appropriate diagnostics and treatments to meet their needs.

Patients rely on physicians to provide the highest quality care but physicians also rely on patients to follow through on their care plan once they leave the ED. Establishing a good relationship and engaging in shared decision-making is fundamental to ensuring the best possible results for the patient.

Michael Ybarra
Senior Director of Alliance Development, PhRMA

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Michael Ybarra
Senior Director of Alliance Development, PhRMA

Michael Ybarra, M.D. is a board-certified emergency physician and Senior Director of Alliance Development at PhRMA. In his capacity at PhRMA, Dr. Ybarra leads alliance outreach to provider, multicultural, and LGBT organizations. His issue areas include communications with health care professionals and delivery reform. In addition to his work at PhRMA, Dr. Ybarra works clinically in the Emergency Department at MedStar Georgetown University Hospital.

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How does a strong doctor/patient relationship translate into better quality of care for the patient?

Analysts doing quality assurance exercises generally ask questions such as “Were the right tests ordered? Were the right drugs or other treatments prescribed?” And, of course, “Did the patient get better?”  But a different question usually goes unasked, because it is so hard to answer from medical records:  “What is the quality of the doctor-patient relationship?” In many cases, the doctor-patient relationship may be the most important element in identifying and treating the patient’s problem.  Is the patient depressed? Are there stressors in the patient’s life that are causing symptoms? A heart-to-heart conversation with the doctor may actually be the best treatment.

Prevention should be an important element of most doctor-patient interactions, and here the doctor-patient relationship becomes particularly important.  Physicians should be advising their patients on diet, exercise, stress, sexual behavior, alcohol and tobacco use -- and some physicians are styling themselves as practitioners of “lifestyle medicine” and focusing on such counseling. But absent a strong doctor-patient relationship, their words of wisdom will fall on deaf ears. The key is trust – trust enough to have that conversation, or to discuss and agree on the best course of treatment (instead of the patient appearing to accept “doctor’s orders” and then ignoring them). Understanding the patient’s culture in an increasingly diverse America is another key. And approaches to developing a strong relationship with the patient that includes trust and cultural competence are all too infrequently taught in medical school.

For physicians in public health, or who practice “population medicine,” there is the need to consider the community as one’s patient.  Public health physicians are responsible for the health of a community and there must be enough trust developed on the part of that community so that it will accept the physician’s recommendations on, for instance, immunization, environmental health, or safety. It used to be called “bedside manner.”  Now it’s called “doctor-patient relationship.”  Whether the relationship is with an individual or a community, this element of the art of medicine is often the most important component of medical practice.

Daniel Blumenthal
President, ACPM

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Daniel Blumenthal
President, ACPM

Daniel S. Blumenthal, MD, MPH, FACPM, serves as ACPM’s 45th President. Dr. Blumenthal is Professor Emeritus at the Morehouse School of Medicine in Atlanta GA, and former Professor of Community Health and Preventive Medicine and Associate Dean for Community Health at Morehouse. He also was the Founding Chair of Morehouse’s Department of Community Health & Preventive Medicine from 1984-2009.

Dr. Blumenthal has been a Fellow of the College since 1987, serving ACPM in many capacities over that time. Currently, he represents ACPM and Association for Prevention Teaching and Research (APTR) on the AJPM Board of Governors, was elected and served as ACPM’s General Preventive Medicine Regent from 2006 to 2010, and served on ACPM’s Graduate Medical Education Committee from 2000 to 2005. Among his many recognitions and awards in the field, he has received the Leonard Tow Humanism in Medicine Award from Morehouse School of Medicine in 2005, the Distinguished Alumni Achievement Award from Emory University Rollins School of Public Health in 2009, and the Duncan Clark Award from APTR in 2010.

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How does a strong doctor/patient relationship translate into better quality of care for the patient?

When we look at the relationship between doctor and the patient, there is one theme that is constant: putting the patient first. The responsibility stands squarely on the shoulders of the physician from the onset to help make the patient feel comfortable and prepared to engage in an open and honest dialogue to help formulate a treatment plan.

In many ways, the special relationship is a moral one with the patient putting their faith in the hands of another individual in the hope of a positive outcome.

When meeting with a patient, it’s important for physicians to remember they’re speaking with a person afflicted with a disease, rather than putting the emphasis on the disease itself.  Oftentimes, underlying issues not directly related to the patient’s illness can make all the difference in how a patient feels about their treatment. This means it’s critical to have direct communication with the patient, accessibility with the family, and sympathy for what the patient is going through at a difficult time in their life.

A strong relationship with a patient, and often his or her family, builds a foundation for a “health partnership,” necessary for successful treatment. This transcends into ensuring information is flowing between a patient and their family to the physician. With a patients history clearly presented to the treatment provider, the quality of care to the patient will receive increases.  

Finally, listening to the patient is critically important to the preservation of a good doctor and patient relationship. Often, patients who feel uncomfortable sharing pertinent and sometimes sensitive details about their medical history do so at their own peril.

On National Doctors Day I join with physicians all across the globe who share in a passion for the enhancement of our patients quality of life. Together, with doctors and patients sharing knowledge and vital health information, our health care system and the care we are able to provide is enhanced.   

Bill Chin
EVP, Scientific & Regulatory Affairs, PhRMA

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Bill Chin
EVP, Scientific & Regulatory Affairs, PhRMA

Dr. Bill Chin leads PhRMA’s Scientific & Regulatory Affairs department. A physican, an endocrinologist and an academic at heart, Dr. Chin envisions establishing PhRMA as the premiere convener in advancing drug discovery and development, regulatory sciences and collaborative partnerships.

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