Episode 128: Relationships Hold the Key

Speaker 1:
You're listening to Your Practice Made Perfect. Support, protection, and advice for practicing medical professionals. Brought to you by SVMIC.

Jay:
Welcome back to our podcast, Your Practice Made Perfect. Today's episode will focus on the importance of patient and physician relationships, along with ways you can currently improve them. We have compiled lessons learned and conversations from past episodes to create today's show. SVMIC's Katie Musacchio is here with us once again to narrate today's episode. Welcome, Katie.

Katie Musacchio:
Thank you, Jay. It's no secret that physicians have an abundance of responsibilities. We wanted to give you a few tips and anecdotes from prior episodes on how to enhance your relationship with your patients. Hopefully, these snippets of information we've gathered can help create more fulfillment in your practice and help ease some of the stress you face as a provider each day.

Katie Musacchio:
In a prior podcast episode of ours, episode 49, Taking Your Practice Online, we spoke with Dr. Kevin Pho. Dr. Pho is a board certified internal medicine physician and the founder of KevinMD, social media's leading physician voice. He talked about the pros and cons social media has had on the healthcare industry. He explains the importance of your online reputation and how you can get started in this realm if you haven't already.

Katie Musacchio:
This is a forefront topic since our world has become so digitally based since the pandemic, and most of your patients will have searched for you online before ever stepping into your office. Let's take a listen to Dr. Pho's advice.

Dr. Kevin Pho:
More patients today aren't just going online to research diagnoses and treatment options. They're going online to research their doctors as well. I talk to patients all the time, and when I meet them for the first time in the clinic, they say, "Dr. Pho, I Googled you online and I know this and this about you. I know where you went to school." They know more about me than I know about them.

Dr. Kevin Pho:
And I think if you look at some statistics, it's like 60 to 70% of patients, they Google their doctors online. They do research just like they do research with a hotel or a restaurant. They do research on their doctors as well. And if doctors don't have an online presence that they control, like it or not, they have one already. You have these third party rating sites that are out there and they get a lot of public data that may or may not be accurate and put it on a profile to make profiles of every single physician in the United States. And a lot of times it may not be to that doctor's liking.

Dr. Kevin Pho:
So I've always say it's imperative to control one's online reputation. Be proactive about defining yourself online and never be defined by someone else. And I'm sure we're going to talk later on about some of the ways that we can do that. But when we talk about how important that is, it's really that first impression online that you give to patients because they're going to be Googling you.

Dr. Kevin Pho:
I think the point that resonates with most physicians is really that online reputation piece. The fact that patients are googling them and if they don't have an online presence already, they're going to have one made for them by these third party rating site. And we're talking about places like Rate MDs, Vitals, Health Grades, and Yelp. And it only takes a few hours to claim and make an online presence.

Dr. Kevin Pho:
I think every online presence, they have things in common. They have your bio and your headshot, and I think that it's important to start there. Have a professional headshot. Have a bio that's well written, so people who find you on a web can know about you, and then go to one of these rating sites and claim your profile. You can go to a Vitals and Health Grades and claim your profile, personalize that page, and you could leverage your online presence with them already and personalize it by putting in a bio that you custom wrote or a headshot.

Dr. Kevin Pho:
Then there are two sites that I recommend, LinkedIn and Doximity. These are professional physician social networks. Well, Doximity is. LinkedIn, of course, is a professional social network. And a profile in these sites are really just digital translations of a physician's CV. And I think that it's important to be on these sites specifically because they actually rank high when your name is Googled.

Dr. Kevin Pho:
And if they Google your name and they find you on these sites and they see professional information, that's something that you can define online that you would want patients to see. And I think all of these things takes no more than an hour or two to do. And at minimum, every physician should at least start there.

Dr. Kevin Pho:
Now, whether they choose to move forward and go on Facebook, Twitter, YouTube, or start a blog, that's really up to them. And it depends on what a physician's goals are because there are some doctors who may want to use social media to educate patients like I mentioned earlier. There are some doctors who may want to connect with their colleagues and learn from them. There are may be some doctors who want to discuss healthcare reform and some of the more provocative and controversial issues of healthcare. And I think it depends on what those goals are because there are specific platforms that fit those goals.

Dr. Kevin Pho:
And of course there are some doctors who may not want to do any of those things, in which case they can stop after creating a profile in LinkedIn, Doximity, and there. And for that, they'll be already ahead of the curve. So once they start that basic step, whether they want to move forward is totally up to them.

Dr. Kevin Pho:
I think there are services that can help a physician build their online presence, but I think when you use a third party service or if you outsource it, you lose your authenticity, you lose your voice. If you don't have any time and you want to outsource it, certainly it's better than nothing. Be careful who you outsource it to. But I think that a lot of these social media platforms are easy enough for the individual physician. And I do want to highlight what you said earlier about it being an individual decision.

Dr. Kevin Pho:
I talk to a lot of doctors and they say, "Why do I have to use social media? A lot of people are telling me that I have to use social media. I don't know where to start." So I think that gets a little bit backwards. Physicians shouldn't use social media for the sake of using it. They need to start with specific goals in mind. And that's what I try to impress on doctors when I talk to them. Why do you want to do it? And then they start thinking, "Hey, I want to educate patients. I want to talk about the latest in healthcare reform." And that really clarifies the goals for them. And once they have those goals, there are, like I said earlier, there are specific platforms that fit those goals.

Dr. Kevin Pho:
For instance, Facebook. I think it's a wonderful way for physicians to connect directly with patients and educate them. You could have a professional Facebook page for your practice where you could do that. I think Twitter specifically is great for doctors to talk to one another and learn from other thought leaders. For doctors who may be more comfortable on video then of course you could do YouTube or Facebook or even Facebook Live and have real time interaction.

Dr. Kevin Pho:
The beauty about social media is that there are so many tools that fit not only an individual physician's strength and personalities, but their individual goals as well.

Katie Musacchio:
Your relationship with your patient can already begin before the first appointment based on how you're viewed online. Dr. Pho made a great point that you should try to control the way you're seen online by creating your own accounts and presenting yourself in the way you wish to be seen.

Katie Musacchio:
Having a good relationship with all of your patients also comes from the way you interact with them during visits. Another prior guest we've had on our podcast is Dr. Rebekah Bernard. Dr. Bernard is a family physician and author and a national speaker on the topic of physician wellness. On episode 58, It's All About Attitude, she discussed her book with us titled The Rockstar Doctors Guide: Change Your Thinking, Improve Your Life. Let's take a listen to her explain the details of this book.

Dr. Rebekah Bernard:
A long time ago when I was in my residency, I had an attending that told me that, "Every time you're in front of a patient, you're on stage." And I really held onto that idea. I realized that we really, as physicians, we have to always give out the appearance and the affect that patients are looking for and what patients want.

Dr. Rebekah Bernard:
And it can be hard sometimes because we may have days when we're not feeling well, we may have just given somebody else bad news. And so we're not really feeling particularly chipper or upbeat, but when we walk into that next patient room, we're really on stage in front of that patient. We're kind of putting on a little bit of a performance, if you will, for them. So the book tries to teach doctors how to get on stage and how to give that appearance of being the ideal doctor that patients are really looking for.

Dr. Rebekah Bernard:
And when you do that, number one, if you're not in a really great mood to begin with, sometimes you can actually feel better just by acting a little happier and acting a little more into the experience. And secondly, you get a lot more out of your patients that way if you walk in with a certain type of an attitude, you actually can motivate your patients to be better with you.

Dr. Rebekah Bernard:
So getting on stage helps you as a doctor and it helps you get more out of your patients. I came up with 10 different rockstar rules, and some of them are more important than others. The number one is that really you are on stage. And so you want to portray those qualities that patients are looking for. One of the biggest qualities that patients are looking for is a doctor that has an affable personality.

Dr. Rebekah Bernard:
Sometimes you hear them say that there's the three A's of what people want and it's availability, which is actually the number one thing people want. They want their doctor to be around when they need them. Affability, which is just somebody that's likable and that somebody that they'd just like to hang around with. And the third is ability, which is interesting. And because that's the thing that patients are the least interested in. They sort of expect that all doctors know what they're doing. So what they're looking for really is the availability and the affability.

Dr. Rebekah Bernard:
So you want to portray the type of doctor that's just kind of a nice person and a person that's interested in them and just kind of a person that they wouldn't mind just hanging around with.

Speaker 6:
Sure.

Dr. Rebekah Bernard:
So the best way to do that is really number one, just to listen to your patients. And that's something that doctors are not always very good at. In fact, I think the studies show that we interrupt our patients in about 22 seconds of them talking. And if we would just let them talk a little bit longer, they say, actually six more seconds, they would actually finish what they were starting to say and they would feel as if they were heard. So in the book, I call it six seconds to rockstar, which is just giving people a few extra seconds to finish what they're saying and just listening to them, it makes a big difference.

Dr. Rebekah Bernard:
So the key to having patients feel heard is to listen to them and to repeat back, do something that's called emotional mirroring and verification and validation. So in other words, when you have a patient that has a laundry list of complaints and problems, number one, we as physicians need to acknowledge that we cannot solve or remedy everything on that list, at least not today.

Speaker 6:
Right.

Dr. Rebekah Bernard:
But we can listen to what they have to say and we can acknowledge that we've heard it and let the patient know that we've heard it. And the way we do that is when they say, "Well, also my head hurts and it runs down the back of my neck and then my toe tingles." You can say, "So you said your head hurts, it runs down the back of your neck and your toe tingles. Is that right?" And they say, "That's right." And then you say, "Well, that must be very uncomfortable." So you just acknowledge what they said. You verified that you had it right, and then you gave them some validation of their feelings. That's all you have to do.

Dr. Rebekah Bernard:
You don't necessarily have to solve it. Then you can say, "But I can't talk about all of that today because we have some other issues that are more pressing. So I want to focus on the diabetes. That's the main issue today. And then next time we'll get more into these other situations, these other pains and symptoms that you're having."

Dr. Rebekah Bernard:
When you talk about showing empathy, a lot of doctors have empathy, but they may not be that great at showing empathy to their patients. And there are some tricks that doctors can do that are pretty simple. One is just simply smiling. Just by smiling at a patient, you're showing them that you're warm and you're friendly and that you care for them.

Speaker 6:
Right.

Dr. Rebekah Bernard:
Another is a little bit of physical contact, just shaking hands or putting your hand on their elbow or their shoulder and then doing what we call active listening. So you're not just listening, but you're showing that you're listening by nodding your head, by giving them those verbal cues like, "Yes, I hear you. Go on." So those kinds of things can show more empathy towards your patients. And even just sitting down while the patient's talking and not standing over them or standing with your hand on the door.

Dr. Rebekah Bernard:
It is scary to be a patient. I think doctors, we need to remember that. And sometimes it's good for us to sit up on that exam table and to remember what it feels like to be in that position. It's a good experience. We may be saying something for the 100th time, but it's the first time that patient's ever hearing it. It's the first time that they've ever experienced a particular procedure, even though we could do it in our sleep.

Dr. Rebekah Bernard:
So we do need to have a lot of empathy for what people are going through. And sometimes it helps for us to go through an experience just so that we realize what it's like. It's scary.

Katie Musacchio:
SVMIC spoke with Dr. Scott Fowler in 2019 as well. Dr. Fowler is the president and CEO of Holston Medical Group. This conversation exemplifies the approach of professionalism in healthcare. Dr. Fowler explains his take on what professionalism means as a physician and how important this role is in our society. Let's take a dive into Dr. Fowler's discourse.

Dr. Scott Fowler:
I think what you have to understand about medicine, and it's true about law, so I want to kind of bring this idea that there is something specifically very important that's different in medicine than it is in many, many, many other occupations. And there are other occupations that may use the term professional to describe those people. What professionalism really is a recognition that you're in a bargaining position visa vi, the person that you're supposed to be taking care of or you're supposed to be responsible for. You're in a position where the bargaining position is such that unless you're very intent on putting that person well, before yourself and before other things, that can allow you to very easily put yourself first for other patients.

Dr. Scott Fowler:
So that happens in law, and everybody knows the lawyers are supposed to be making a lot of decisions that are focused on what are the rights of their clients. But it's true in medicine too. And I think it's gets lost a little more easily in medicine. When you become a doctor, you know this from the start, you know that when you raise your hand and you take the oath, that the oath is to above all, do no harm, to put your patient first, to recognize that medicine is something that's... The right to practice medicine is something that's given to you.

Dr. Scott Fowler:
You earn the right to stand in line. But in the end, society makes a covenant with you and says, "Look, you have all this information, you have all this knowledge, and now we're going to give you a license that gives you a monopoly. And what we're asking you to do in return is promise us that you'll recognize the practice of medicine is not a business, it's not a trade, it's a calling."

Dr. Scott Fowler:
And it's about exercising a very complex combination of science and art and getting along with patients in a way that benefits... It will benefit you, there's no question. Professionalism makes the practice of medicine what it is, but it ultimately benefits the patient and society. And the only other versions of medical care are purely business versions or sort of medical industrial versions where patients are sort of widgets and doctors are laborers. And those are very non-productive, both from the point of view equality and the point of view of satisfaction for patients and for doctors.

Dr. Scott Fowler:
So that's my definition of professionalism. It's really a recognition that you have received something and you've promised, you made an oath, to profess means to promise. So a professional promise is very different for instance, in a labor union, you have a bunch of people to get together in a society or in a group. Their interest is themselves. They're there to advocate for themselves, they're there to advocate for better pay, better working hours, things like that. A profession is also an aggregation, but it's an aggregation where what you're doing is you're advocating for somebody other than yourself.

Dr. Scott Fowler:
You're actually advocating for the patient. And to do that, you sort of have to recognize that there are several parts. And so the second part of professionalism is to realize it's an oath, but it's also to realize that it's more than an oath just to the patient. It's an oath to put the patient first. But in order to do that, you also have to put the profession, you have to recognize your relationship with the other professionals that are in the care models with you, are just as important as your relationship with the patient. So you can't let that get interrupted, discoordinated anymore than you can your care with the patient.

Dr. Scott Fowler:
And then lastly, it's an oath that you took together, you and the rest of your colleagues to care for everybody. It's with society. It's not about does somebody have insurance and does somebody not? So, ultimately we have to figure out together with society how this thing's going to work. So that's long winded. It is kind of a long winded way to say this is the cornerstone. Without this, there is no profession of medicine. It doesn't exist. And professionalism is the thing that makes medicine work. It's the cornerstone.

Dr. Scott Fowler:
I tell a story about when I first put on a white jacket after I'd finished medical school, and I think I was still a student quite frankly, but I walked into a room and there were a lot of people moving around in the room, but it was an older woman and she was pretty sick, and there was a lot of discussion about what was going on with her. But at the end, like medical students do, I stayed in the room after everybody else left to do whatever the things were that I was going to do.

Dr. Scott Fowler:
And she called me over and I had the short white coat on back then. That's what students wore, but it was a white coat. And she called me over and she said, "Doc, what do you think I ought to do? You heard all of this. What do you think I ought to do?" And I'm sitting there thinking, "Listen, I'm a medical student, okay? Why are you asking me this incredibly important question about your life and you're going to make this decision?"

Dr. Scott Fowler:
And when you put that coat on, you didn't earn it. It got given to you. The patients understand and respect you because you're in the banner of professionalism, and you're absolutely right. If you let, for a minute, if you let your guard drop and you fail to recognize that they are putting their life in your hands, basically, and they do it willingly because they expect the return and the return has to be there.

Dr. Scott Fowler:
There can't even be the appearance that there's impropriety in what you're trying to do there. So I agree with you and it's very special, and lawyers do have this too, and there are other things, but for medicine, without it, the whole thing falls apart. It becomes a charlatan, it becomes snake oil salesman. It becomes people trying to figure out how many of this they can do and how many of that they can do to make money. And look, medicine has a business. In other words, you can't sustain anything in a marketplace unless you figure out how to run it as a business.

Speaker 6:
Absolutely.

Dr. Scott Fowler:
But medicine is not at its heart a business. It's something that has to stand above that. And it's like I tell my colleagues here, and we all agree on this, "If we can put the patient first, if we can recognize that's how we do our job well, all the rest of it comes." Society actually wants doctors to have status. They give it to them.

Speaker 6:
Yeah.

Dr. Scott Fowler:
Doctors don't earn it. They just get it by being a doctor. They want doctors to make good money. They don't want, they're not making decisions about that. They expect highly educated people who are out there that they're calling on to have money to live their lives and to have good status in their lives. So we don't have to struggle for that. That will be there, and it always has been there. We just have to respect that the way we earn that is quite frankly, by being professionals.

Katie Musacchio:
If we combine the perspectives of Dr. Pho, Dr. Bernard, and Dr. Fowler, we're truly given a well-rounded approach to improving patient care and relationships. Thank you once again for tuning into my narration of today's show. And with that, I'll hand it back to Jay.

Jay:
Thank you, Katie for narrating this topic of conversation for us. Relationships are so important to cultivate and maintain. So we hope taking you through the insights of our prior guests has been a benefit to you and your practice. Thank you for tuning in, and please feel free to visit our show notes to listen to the full episodes mentioned throughout today's show.