Datta 1

The Doctor-Patient Relationship: Using

Positivity to Speed Up Recovery
Henna Datta
Mentorship GT
4/24/2020

Mentor: Dr. Usha Sivakumar

Internship: SiviMed Internal Medicine and Primary Care
Instructor: E. Leila Chawkat
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Abstract

Doctors have a certain level of responsibility when it comes to the overall health of their
patients. However, the magnitude of this responsibility has been highly debated. Doctors are able
to prescribe medications, recommend treatments and lifestyle changes, and provide valuable
advice, but once a patient leaves the office, they must follow the doctor’s instructions in order to
improve their health. This is especially true among patients with chronic illnesses such as
hypertension, a condition that is treated mainly through careful changing of habits. This paper
will discuss the aspects of a doctor-patient relationship that can be utilized to maximize treatment
effectiveness and patient compliance. The main goal of this study is to determine the connection
between the different components of the doctor-patient relationship and the condition of the
patient by successfully collecting related data from patients who suffer from hypertension. The
results gathered from this study could be used to help decrease the number of deaths caused by
hypertension by providing information for doctors to use when communicating with a patient.

Table of Contents

Introduction……………………………………………………………….2

Literature Review………………………………………………………....3

Data Collection and Methods……………………………………………..8

Results and Analysis……………………………………………………...12

Conclusion………………………………………………………………..14

Works Cited………………………………………………………………16

Introduction

The typical patient-doctor relationship is complicated and has many different

components. There should be mutual respect, a high level of trust, and a solid method of

clear communication. A patient’s experience in a doctor’s office should be pleasant, as

patients that are treated poorly by staff are more likely to grow frustrated with the

practice as a whole and lose trust in the physicians that treat them. Communication
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between doctors is also essential because it ensures that a patient is being treated fully,

with all necessary information readily available regardless of the doctor being seen.

These aspects of the doctor-patient relationship can ultimately be utilized to maximize the

effectiveness of treatment for patients. A positive doctor-patient relationship will

ultimately benefit the patient physiologically, and by adequately utilizing communication

tactics and personability, both the doctor and patient will be able to flourish​.

Literature Review

Hypertension Background

Hypertension is a condition in which a patient suffers from high blood pressure.

Although the symptoms are manageable, and the condition is easy to treat, there are a lot of

potential complications that can prove fatal for a patient (Rizzo). Utilizing a positive

doctor-patient relationship to encourage patient compliance ultimately helps to decrease patient

recovery time and mortality rates for people with hypertension. However, a positive

doctor-patient relationship can improve the patient experience for people with a wide range of

different chronic conditions and illnesses.

Trust in the Doctor-Patient Relationship

Increased trust in the doctor will increase the chances of a patient following prescribed

treatment, thus allowing a patient to improve faster. Doctors should always attempt to make

patients feel informed and aware of everything that is going on with their health. Patients

generally want to trust their doctors but remain relatively cautious when following treatment

(Coulter). The development of better and more advanced technology has allowed patients to have
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greater access to information relating to possible afflictions, meaning that they are now able to

make informed opinions on their own conditions when talking to their doctors. In order to

function in these changing times, doctors must be taught using “knowledge of patient’s

perception of care to focus [on] areas that will help [them] to meet patient’s expectations' '

(Meryn). However, they must do this without catering too much to a patient’s potentially false

ideas about their own conditions, thus making sure to establish themselves as the authority figure

in diagnosis. Patients have now been found to have unrealistic expectations about the treatment

that they feel they are going to receive because they are under the impression that the

information they get from the internet is going to be correct (Ray). Providing sufficient evidence

for their claims will give patients more reason to trust their doctors. The best way to do this is by

allowing patients to “voice their concerns without being sidelined” (Aaltonen). This tactic is

especially important when doctors are informing their patients about complicated issues that

often involve misinformation, such as with vaccine hesitancy, while making sure the patients still

feel that their concerns are being sufficiently put to rest.

Encouraging Accountability

By encouraging patient accountability, doctors can give patients a greater feeling of

responsibility when it comes to their own health, instilling in them the belief that treatment is

worth being followed. Showing patients and trust-building with patients will help them to find

their own sense of responsibility, and be rid of any fears that they might have had prior to

discussing with a doctor (Worcester). It is important for the patient themself to feel as if they are
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in control of their own health, without there being significant discrepancies between the doctor’s

prescribed treatment and the patient’s perceived best course of action. In order to benefit both the

doctors and the patients, hospitals and practices must develop a shared mindset with the patient,

targeting optimal outcomes with low overall cost for both the patient and doctor. The best way to

do this is to allow them to utilize technology to help them manage their own illnesses

(Snowden). In current times, there are many ways for patients to keep track of their own weights,

blood pressures, and many other vitals that will benefit the doctors when evaluating the patient in

the office. This will especially help for patients with chronic illness, where consistent

information on the patient such blood pressure will be beneficial for helping the provider

determine the causes of the illness. Chronic illnesses are sometimes inadequately managed, due

to an overestimation of care provided, a lack of education, and a lack of a proper treatment plan

for patients. Creating a better treatment plan for patients to follow independently would help

increase their involvement in their own treatment, and allow physicians greater time to work

with other patients (Salisbury). By trusting the patient with the responsibility of taking care of

themselves when not directly with the doctor, the doctor is helping the patient to learn how to be

partially self-sufficient, and thus not overly reliant on the physician.

Doctor-Patient Communication

Healthy and consistent communication between doctors and patients will allow for a

more positive relationship between the two as well as making it significantly easier for the doctor

to make informed decisions for their patients, such as with diagnoses and prescriptions for

treatment. Improved communication between patients and doctors will lower recovery time and
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have a significant positive impact on a patient’s treatment experience and increased

communication will maximize the quality of care for pediatric patients, especially relating to

psychosocial issues (Pidano). The more communication that takes place, the more likely it is that

the doctor can understand the patient’s condition fully. It is difficult for this to occur if there is

information missing. Sufficient communication between specialists will help make sure that

primary care physicians are able to treat patients based on their exact needs (Escobar). There also

needs to be sufficient communication between doctors and nurses. This is because nurses and

doctors both interact with patients in different ways, so they both have different experiences with

individual patients. In order to fully understand the patient, all practitioners working with a

patient need to work together. Communication between nurses and doctors will help medical

staff to more fully understand the patient experience, because physicians “treat disease based on

what they can hear, see, and count; [while] nurses view disease as a life experience” (Arford).

This perspective comes due to the fact that nurses often involve themselves much more deeply

with patients, attending to their vitals and needs before the doctor does, thus making their

interactions with patients more personal. With thorough communication between all members of

a patient’s medical care, the treatment effectiveness can be maximized to benefit the patient the

most.

Methods to Improve the Doctor-Patient Relationship

Incorporating modern care methods such as telemedicine and behavioral health services

in addition to baseline primary care would help to enhance the patient experience while

encouraging more comprehensive care for the patient. This would allow doctors to be able to
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fully evaluate every aspect of a patient’s condition and, in geriatric patients, improve the

accessibility of care. When evaluating a patient, it is essential for doctors to take into account

their physical as well as their mental health. Mental health screening tools are often used in

smaller primary care facilities, but the integration of behavioral health providers into a patient’s

care can “play a key role [in treatment] by helping to foster effective collaboration, mutual trust,

and shared goals and roles.” (Nielson). With the inclusion of additional background knowledge

that is deeply personal to a patient, primary care physicians will be able to more effectively

diagnose and treat them. One concern with the integration of such care is that it may be difficult

for patients to find the time to address behavioral health issues, especially due to societal stigma

and cost. However, the integration of telehealth services can “introduce telepsychiatry and

remote consultation to increase reliable, timely access [for patients]” (Nielson). Behavioral

evaluations do not have as great of a need as physical evaluations to be present with the patient,

which makes them a lot easier to carry out online. Telemedicine is a recent innovation that will

greatly and drastically improve the communication between doctors and patients. Telemedicine

has proven itself to be an effective method of treatment overall, though, it should not be used as a

replacement for in-person appointments with doctors. Many critics of the practice are concerned

that it would lead to “incorrect diagnoses, unnecessary prescriptions and duplication of care”

that stems from multiple practitioners working with one patient (Glauser). This concern has led

to some hesitation in accepting telemedicine, especially in smaller practices. However, this issue

can be remedied by a focus on continuity of care by keeping the care provider consistent, and by

keeping strong communication between all of the patient’s practitioners (Dermer). Telemedicine

as a whole has many undeniable benefits for the patient and all of his or her practitioners.
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Telemedicine is especially beneficial for elderly patients who may have trouble traveling to and

from the doctor’s office regularly. Elderly patients who suffer from chronic diseases such as

heart failure and hypertension need consistent care, so telemedicine is an effective way to

monitor them consistently without requiring frequent visits to a doctor (Zulfiqar).

Data Collection

Rationale

Data about individuals with hypertension gathered using AthenaNet, a program used to

store patient records for patients at SiviMed Primary Care and Internal Medicine, was gathered

and analyzed. The average number of visits per month, whether a patient’s blood pressure

lowered and stabilized, and basic aspects of medical history, such as bmi and age, were recorded

on a spreadsheet. This data was then used to show how an increase in average visits per month,

which indicates an increase in quantity of communication between the doctor and patient,

impacts patient recovery. Initially, this data was to be supplemented by information gathered

from an interview study of a sample of around 150 of the patients with hypertension. They were

to be called and asked a series of questions regarding their feelings of satisfaction, their

perspective on how their hypertension has improved over the course of their time at SiviMe d

Primary Care and Internal Medicine, and the treatment that they have been implementing away

from the doctor’s office. A similar script would be used for each patient in order to ensure that

the data is consistent. This combination between qualitative data collection and an interview

method was intended to help create a more comprehensive understanding of the data and the

patient population studied. However, due to current international circumstances, it was made

impossible for this aspect of the data collection to be carried out. See figure one for the baseline
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script and questions that were initially drafted. In addition to the interviews and quantitative data

collection, the researcher took note of interactions observed in the office, including televisits,

emergency appointments, and regular check-ups.

Results and Analysis

Figure 1. ​Interview Script

This figure depicts the script initially designed to be used when interviewing patients. The questions are all
open and centered on the patient and their individual experiences.
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Figure 2. ​ Average Visits on Most Recent Systolic Blood Pressure

For this figure, the most recent systolic blood pressure for every hypertensive patient was taken. In order to
show consistent data, patients who showed a decrease in blood pressure were standardized for this graph to
have a most recent systolic blood pressure of 110, while those who showed an increase or consistently high
blood pressure were shown to have a systolic blood pressure of 140.
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Figure 3.​ Average of Average Visits per Month

Average of
Average Visits Per
Month

Decrease in Systolic BP 0.964572145

Increase or Stable Systolic BP 0.832244174

Grand Total 0.90977554

This figure shows the average of the average visits per month for all of the patients showing improvement
in blood pressure and all of patients with an increase or stable blood pressure.

Figure 4.​ Average # of Visits Since Diagnosis

Average of # of
Visits Since
Diagnosis

Decrease in Systolic BP 3.609022556

Increase or Stable Systolic BP 2.914893617

Grand Total 3.321585903

This figure shows the average number of visits since the

initial diagnosis for patients that showed a decrease in
systolic blood pressure and for those who showed either
an increase or a stable systolic blood pressure over time.
DOCTOR-PATIENT RELATIONSHIP AND PATIENT RECOVERY Datta 12

Figure 5. ​Average # of Visits Per Month (Rounded)

This figure shows the number of patients who improved and worsened against the average number of visits
per month.

Analysis

The data collected showed that increased trust, accountability, and communication results

in quicker recovery time and fewer overall visits. With patients who come in more frequently

and are following treatment more carefully, their blood pressure will come down in less time,

and they will report feeling high levels of trust in their doctor. Those who do not feel as much

trust will not follow their treatments as carefully, and will not show as big of a difference in

blood pressure. The individual pieces of data showed the patient population at SiviMed Internal

Medicine and Primary Care showed a statistically significant difference between the average

number of visits for patients who improved and the average number of visits for patients who
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either remained the same or worsened in their condition, where the average number of visits for

improving patients was 0.964 and the average number of visits for worsening patients was 0.832

(Figure 3). Additionally, the average number of visits since the initial diagnosis for patients was

much higher for patients who improved than for patients who did not. According to Figure 4, the

average was higher by one visit for improving patients. The largest number of improved patients

showed to have an average of around one visit per month (Figure 5). This is likely due to the fact

that patients who visit too often are likely doing so because they are struggling to decrease their

blood pressure or because they feel a dependency on their provider to the point where they need

to visit very often.

The inclusion of an interview study would have been used to help determine what is

happening specifically that would potentially improve the patient experience while displaying an

individual patient’s feelings about the practice and the methods implemented on their own

treatment. The researcher did observe several appointments, both online and in person, and noted

that the doctor observed often “used touch as a way to provide comfort to their patient by

hugging each of them before they leave the office”. This practice seemed to make the patients

feel comfortable, and many of them left talking about how appreciative they felt towards the

doctor. The calls observed showed that, despite the lack of physical presence the doctor had with

the patient, the camera was used to show the doctor different physical symptoms the patient was

displaying, and the communication seemed to be hindered only slightly, because the doctor could

not check the patient herself. The main discrepancy with this research method was that, without

the inclusion of the interview, it is difficult to determine whether the observed changes between

patients who improve and those who do not can really be attributed fully to the number of visits
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that the patient has. However, the data has shown that these results are statistically significant,

meaning that there is a clear correlation between number of visits and time it takes for patients to

improve. Had more qualitative data been collected, this evidence would likely be even stronger,

as it would be supported by personal accounts by the patients.

The data collected helps to determine a positive doctor-patient relationship, in which the

patient visits an average of around once a month, can have an impact on the improvement rates

of patients. Additionally, according to the observational data collected, a more relatable and kind

doctor can result in more comfortable patients, thus improving the patient experience. With

further, more extensive research, this data could prove to be a way to help doctors maximize

their patient’s treatment effectiveness, and make sure that they are behaving in a way to help

patients improve more quickly, thus improving the patient’s quality of life.

Conclusion

By utilizing proper communication, establishing trust with the patient, encouraging

patient accountability, and implementing new tactics such as telemedicine and behavioral

health integration, thorough evaluation and accurate diagnosing of a patient will be easier

for the doctor. These methods will also make conditions such as hypertension quicker to

treat and easier for both the doctor and patient to manage. There should be clear

communication between doctors and nurses, as well as between doctors and patients

because doctors and nurses share different experiences in the field, and thus have

different expertise. Proper communication will result in better trust, and an overall better

treatment compliance rate, which will allow patients to get better, faster, and in a way
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that is more financially reasonable. A stronger relationship will also result in greater

empathy between doctors and patients because improved communication will make it

easier for the doctor to understand their individual patients and shape their delivery of

information based on that. The work towards an improved quality of life for patients

should be an effort made by all practitioners and parties involved with the patient.

Doctors and patients working together to form a strong, collaborative doctor’s office

experience will result in quicker treatment responses and an overall more cohesive

treatment.
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