The Doctor-Patient Relationship: How it Impacts Your Care

Dr. Bradley Warady, Director, Division of Pediatric Nephrology

When I started practicing medicine more than three decades ago, it wasn’t uncommon for a doctor to merely tell his patient – this is what you need to do to get better- and assume that the directive would be carried out. There wasn’t a two-way conversation or feedback from the patient and family that was taken into consideration when devising the treatment plan. But times have changed, and for the better. Fast-forward to today and now with an increased emphasis on family engagement and greater acknowledgement of the importance of patient and family input on treatment decisions, improvements in the manner care is being provided as a result of a different and better doctor-patient relationship is beginning to have an impact on outcomes. This isn’t something necessarily taught in medical school or read about in a medical journal; it’s an important development learned firsthand from patients and families over the years.

Practical Management Recommendations

To improve outcomes, health care providers must take the family’s everyday lives into consideration when making management decisions. To help us do that, our team at Children’s Mercy regularly meets with the parents of our dialysis and transplant patients outside of normal business hours. We sit down with the parents (or they may call in on a conference line) and we discuss how we can further improve their child’s care. We ask them to share their thoughts about their children’s school, their children’s relationships with peers and siblings, the difficulty the children have meeting all of the medical demands and the impact that these and other related issues have on their own lives. We solicit their perspective so that we can design a program or treatment plan that is practical for a particular family and, in turn, has a greater chance of being successful.

Of course, they have shared with us that a variety of circumstances need to be considered with devising a plan for an individual patient and family. What are the resources at home? Is it a single-parent household or are both parents living in the house? What is the work schedule of the family? What’s the school schedule of the children? All of these factors and more should come into play when recommending certain therapies. If you ignore these factors, the patient and family may leave the office and say that they will do all of the things asked of them, but in reality they can’t. Not that they won’t, but they can’t. And that’s what we as health care providers have to understand. The medical process, especially as it pertains to complex care, needs to meet the needs of the patient and family, with recognition of the everyday demands that they regularly encounter.

This type of individualized care isn’t easy. It takes work and commitment from both sides. Everyone is busy and it can be difficult for health care providers and families to find the time to sit down and discuss ways to improve the implementation of care. But once we get families to the table and together agree upon treatment plans, which can realistically be implemented, the benefits of the time spent become apparent and families recognize our commitment to work with them as partners and not merely as patients or “customers”.

Surveying Patients: Why Feedback is Important

One of the ways we obtain feedback from our patients and families in the Division of Pediatric Nephrology is by regularly looking at the satisfaction of our patients. We survey our families every time they leave the clinic. We ask them whether the clinic experience met or exceeded their expectations. These brief surveys are extremely valuable as the results help us learn what we’re doing right, in addition to highlighting issues that require attention because they may have a significant impact on the children we’re caring for.

If you don’t collect and use the feedback, I sincerely believe that the likelihood of achieving the goals that you’ve set for yourself and for the families you care for are at risk of not being accomplished. Survey queries addressing a family’s understanding of the treatment recommendations given to them are essential and provides important feedback to the health care team regarding the manner in which medical information is being communicated and the importance of “health literacy” to patient outcomes.

Teen Patients: Make Them Part of the Solution, Not the Problem

The teenage years can be difficult. Teens are already dealing with the normal developmental issues and they are regularly testing boundaries when it comes to independence, responsibility and understanding the consequences of their actions. We all go through this difficult part of life, but throw a complex chronic illness on top of it and the burden can at times be unbearable for these kids.

As health care providers, we need to prioritize their needs as adolescents, while at the same time figure out unique ways to help them understand the importance of their medical care and work with them to design a realistic treatment plan. This has to be an individualized and collaborative process, because every teen is unique, and a thirteen old is different than a sixteen year old or a nineteen year old.

The most important thing we can do is to recognize the variety of complex issues teenagers are facing each and every day and to be sensitive to those issues. By doing that, we can better understand where they’re coming from and they understand where we’re coming from, both of which untimely enhances communication. If we ignore the psychosocial issues that they’re dealing with, we’re going to fail.

Embracing The Patient’s Perspective in Health Care

Improving the provider-patient relationship isn’t exclusive to Nephrology. Appreciation of the everyday challenges that patients and families are confronted with and the need to actively partner to achieve the best possible outcomes should be practiced in all of areas of health care. Providers need to make an effort to actively engage families and children, since they so often can contribute to the solution for problems that exist. As an industry, we need to encourage patient feedback in terms of the approaches that are successful and what’s not successful. Discussing challenges and overcoming obstacles can only improve care.

It takes discipline and the entire multidisciplinary team of doctors, nurses, psychologists, dieticians, pharmacists, Child Life and social workers working together to be successful. Patients aren’t use to being asked by their health care team to help find the strategies that work. Thankfully, that paradigm is changing.

Learn more about the Division of Pediatric Nephrology at Children's Mercy.