Editorial: How to make the doctor-patient relationship work

Time is a major factor in the primary care relationship. Patients don't like long waits for doctors, and doctors are annoyed when patients bring up multiple concerns in time allotted for one. When time is counted in years, the primary physician's complete record of a patient's health limits redundant testing and promotes positive change.

To organize face-to-face time with patients, doctors can use several strategies. My nurse helps to plan chronic illness or physical appointments by generating test orders so data are available at the visit. She enters chart reminders for vaccines and screenings. We encourage patients to bring a list of concerns, medications, and blood pressure and glucose logs. At well visits, they complete a written health history update. My paper-based tools are posted on my Web site, http://synspectrum.com. Some of my colleagues use electronic patient self-assessments.

Some of my favorite Web sites include those of the Centers for Disease Control and Prevention, the Food and Drug Administration, Medline Plus, and the National Cancer Institute. I also download information for patient handouts from the Web sites of the Mayo Clinic and the Cleveland Clinic, as well as direct patients to http://heart.org, http://diabetes.org, http://aaos.org, http://familydoctor.org, or http://kidshealth.org. To supplement publicly available information, I use professional resources such as http://uptodate.com Prescriber's Letter, or Natural Standard. Medical information vendors such as Krames, Zynx, and Healthwise offer high-quality patient education and decision support tools that integrate with EHRs.

Before spending money on health IT options, doctors need to consider the popularity of these choices with patients. For example, how many emails does your practice receive from patients each day?

Appreciation. Patients and doctors both value courtesy. Respect is a two-way street and can be expressed with simple steps, starting with promptness at appointments. Your staff should ask patients how they want to be addressed, make eye contact, and ask about important people or events in the patient's life. Doctors surveyed by Consumer Reports say they appreciate patients who ask questions and challenge treatment recommendations. I also value simple words of thanks and patients who refer family or friends.

Patients appreciate professionalism. This starts with appearance. One patient recently told me she felt doctors and assistants should be dressed professionally every day of the week, in keeping with the high standard of care we aspire to provide. Perhaps we need to reconsider our "casual" Fridays. Other aspects of professional conduct include technical competence, attentive listening, and careful review of patient history and treatment options.