Why physicians need to consider the patient’s perspective

Jennifer Tirnauer and Kelvin Chou talk about the importance of considering the patient's perspective at the HIMSS Conference. (Photo: Ron Southwick)

Most doctors enter healthcare because they want to help people, but due to enormous workloads and tight schedules, some don’t fully address the concerns of patients.

Kelvin Chou, a professor of neurology at the University of Michigan, stresses the importance of doctors considering not just the patient’s health condition but the patient’s perspective in treatment.

“That is something that can only help the physician-patient relationship,” Chou says.

He adds it can lead to better outcomes, with patients adhering to their care plans.

Chou and Jennifer Tirnauer, a hematologist and senior deputy editor at Wolters Kluwer, talked about the value of incorporating the patient perspective in a presentation at the HIMSS Global Health Conference & Exhibition. They also spoke with Chief Healthcare Executive® afterwards about the importance of connecting with patients and making them feel heard.

“If the patient feels heard, that improves trust,” Tirnauer says. “And once you have more trust, the patient is more likely to listen to what you have to say, to follow your instructions, to ask the additional questions that they might have been scared to ask.”

(Jennifer Tirnauer and Kelvin Chou share some thoughts in this video. The story continues below.)

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Asking one key question

In medical training, doctors learn about the primary symptoms of various diseases, but Chou notes that patients may be more concerned with some issues that aren’t immediately apparent or symptoms that may be considered less serious.

In patients with Parkinson’s disease, Chou says, “There are patients who are really bothered by fatigue. And that's not something that's readily apparent, and they may not also have the language to really tell you about it and the impact that has on them.”

When he sees patients, Chou asks a question before the end of the appointment: Has he addressed all of the patient’s concerns? Sometimes, the patients will say he hasn’t.

“A lot of times, I’m surprised at what comes out,” Chou says.

Chou says that question has become an invaluable component of his encounters with patients. “I'm asking them because I really want to know if I'm helping them,” he says.

Even when a patient says he didn’t address certain concerns, Chou says it doesn’t sting. Rather, he’s relieved that he still has a chance to know what’s on the patient’s mind. Plus, he says, “I want to know how to improve.”

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Doctors can’t put their best foot forward every time, but Chou says expressing some humility also offers an opportunity to connect with the patient.

“Even physicians are human,” Chou says. “They have bad days.”

When a patient says some concerns weren’t addressed, he says, “If you're not having that great day, and it doesn't really go as well as you don't want to, really be humble about it and say, ‘OK, I'm really sorry, it's not my best day, but I really do want to help you.’ And to try and mend a relationship that way.”

When patients indicate all their questions have been answered, Chou says, “That's actually what makes me feel good.”

“At the end of the day, I know that I really made a difference in their life,” he says. “And if I know that, I also will be in a better mood the rest of the day. I will treat everyone much better.”

When doctors take that extra step and patients share additional concerns, Tirnauer says she’s thrilled.

“Once a patient feels heard, all of a sudden, like the relationship shifts. There's more trust,” Tirnauer says.

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Focusing on the patient experience

When asked if health systems can do more to entice clinicians to consider the patient’s perspective, Tirnauer says, “I don't think we can make somebody show more compassion.”

However, health systems can help by reducing some of the repetitive administrative tasks from physicians.

“I think most people who go into health care, go into it for the right reason,” Tirnauer says. “They want to help people. They want to take care of people. And there's too much clutter in their brain.”

However, Tirnauer adds that if hospitals and health systems take some chores away from physicians, they shouldn’t simply force doctors to take on bigger loads of patients.

“Don’t take away the repetitive tasks so you can shove in 10 more patient appointments, and the physician only has five to 10 minutes to talk to the patient,” Tirnauer says. Physicians need more time with patients, she says, adding, “If you really care about that, you have to actually build it into your system.”

Health systems have to place a high priority on the patient experience, Chou says. He says it doesn’t necessarily involve mandates on questions to ask.

Rather, Chou says health systems must “build in the process and support so that you can actually concentrate on patients and work at the top of your license.”

Hospitals and health systems that want to improve the patient experience should also ensure they are treating their clinicians and staff well, Tirnauer says.

“Physicians are very aware of the culture and their institution,” she says. “You will be amazed at the way they're treated behind the scenes and then expected to just show up and be super compassionate to the patients.”

Wolters Kluwer has been soliciting patient perspectives for UpToDate, a service offering clinical decision support. Over the past couple of years, UpToDate has featured essays from patients about their experiences battling certain conditions and some of their frustrations in communicating their needs and concerns to physicians.

One patient with sickle cell diseases shared her thoughts about her experience being treated in an emergency department. Some physicians mistakenly view patients with sickle cell as dealing with drug addiction, and this patient shared she didn’t know how to communicate her pain to the staff. Her experience was also hampered because the hospital didn’t have her patient records, which would have shown she wasn’t dealing with addiction.

“That one really hit home with me,” Tirnauer says.