It pays to make nice in doctor-patient relationships

When Dr. David Bazzo graduated from Chicago Medical School in 1990, he was ready to treat patients, but he wasn’t prepared to talk and listen to them.

“I wasn’t taught about effective ways to communicate with patients, because at the time a medical education didn’t encompass such training,” he said. Health-care professionals focused on scientific knowledge and clinical skills, and a good bedside manner was deemed admirable but not necessary.

Times have changed. As the over-50 population has increased, and as frustrated patients have become angry consumers, the medical profession has paid more attention to doctor-patient rapport.

Hospitals now routinely survey patients on the quality of their care. Medical school curricula include training in effective two-way communication. And doctors with poor bedside skills often are enrolled — usually at the insistence of attorneys or medical boards — in remedial classes, such as the Physician Assessment and Clinical Education Program, or PACE, at U.C. San Diego School of Medicine.

“It’s like traffic school for doctors,” said Bazzo, who serves as PACE’s co-director within the UCSD Department of Family and Preventive Medicine. “We are demonstrating that communication with patients, like other procedures in medicine, is a skill that can be taught and learned.”

Bazzo and other experts emphasize that this ability must be mastered on both sides of the doctor-patient fence. Patients must work on relationships with caregivers by shopping around for compatible doctors, doing homework before office visits, and being vocal about what works and what doesn’t.

The best time to build a relationship with a doctor is before one is needed, health experts say, and the half-century mark presents an ideal time to begin scouting.

“People need to become familiar with their doctors before they experience medical emergencies — when you’re sick, you don’t want to be treated by a stranger — and age 50 is a good time to do that,” said Dr. Rosemarie Marshall Johnson, a past president of the San Diego County Medical Society and a patients’ advocate.

Before the era of managed care in institutional settings, “we expected to have the same physician from cradle to grave,” Johnson said. “Now we change physicians as often as we buy cars. When you’re buying a car, you expect to have options, and you ask for what you want. It shouldn’t be any different with health care.”

Such talk of patient empowerment has become a mantra in the medical profession, and leaders in the health-care industry are actively making quality care an institutional priority.

Dr. Thomas McAfee, UCSD Health Sciences’ physician-in-chief, keeps score of how his staff is connecting with patients. “Patient satisfaction and service improvement have become a No. 1 concern for hospital CEOs around the country,” he said.

Even with the best intentions, doctors routinely grapple with burgeoning caseloads and unanticipated emergencies, and the doctor-patient office visit too often seems like a hit-and-run encounter, health experts say.

If a patient is likely to get five minutes of the doctor’s time during a visit, every second counts, Johnson said.

“Go in with a list,” she said. “Write down your chief complaint as succinctly as possible, then write down any major medical problems underlying your health condition. Include any allergies, major surgeries and most important, all the medications you’re taking. Then, when you’re face to face with the doctor, stay on target and don’t ramble.”