Becker's Hospital Review

75 PRACTICE MANAGEMENT THOUGHT LEADERSHIP The Physician-Patient Relationship: Should it be 'Warm Detachment' or Breaking Down Barriers? By Chuck Lauer, Former Publisher of Modern Healthcare and an Author, Public Speaker and Career Coach W hen I was growing up, my mother and father always made sure that when they threw a big party, they invited the family physician and sometimes even their dentist. ey weren't alone; it was a tradition back then to extend a courtesy to people who played any significant role in people's lives. ose memories came flooding back to me when I read an article in e Wall Street Journal about the so-called "new boundaries" between physi- cians and their patients. I like to know as much as I can about any physician who treats me and my family. Where did they go for their medical degree and residency? Do they have a sense of humor? How do their peers feel about them? ese may not be entirely clinical is- sues, but they factor into a relationship, which in my book factors into a good outcome. If you ask physicians for referrals to sur- geons, they will recommend those they feel are most competent. ey have seen them in action and have a pretty good picture of their surgical chops. But what I want/need from a physician may be entirely different from what others are seeking. Professional organizations representing physicians are re- served on the subject of physician/patient relationships. For instance, Wayne J. Riley, president of the American College of Physicians, says doctors should "adopt a posture of warm de- tachment" with their patients. And other professional medical organizations are issuing new policies hoping to help doctors navigate the tricky patient/doctor relationship. Take the Amer- ican College of Obstetricians and Gynecologists, which recently warned members against venting about patients — even anony- mously — on social media. en there is the American College of Physicians and the Federation of State Medical Boards, which released a policy statement in 2013 that included this advice to members: Physicians, they said, "should not 'friend' or contact patients through personal social media" or text "for medical interactions with even established patients except with extreme caution and patient consent." A 2010 paper published in the Harvard Review of Psychi- atry proposed rules for the phenomenon of what they call "pa- tient-targeted Googling." Of some interest is the fact that in a survey of several dozen psychiatrists, most searched for informa- tion about their patients online. It warned doctors against doing so because of "curiosity, voyeurism and habit." Some boundaries in the doctor-patient relationship are pret- ty clear: sex and romance are out. Physicians are advised not to treat their own family or close friends, situations that could com- promise objectivity and judgment. But more and more, docs are getting more personal. In the Journal article, Wanda Filer, a practicing family phy- sician in York, Pa., and president of the American Academy of Family Physicians, states that she finds disclosing some infor- mation about her own life helps "break down that barrier as you build that relationship (between the doctor and the patient)." She feels that by being more open, patients "seem more willing to tell you other things that are going on" healthwise. Dr. Filer says she has attended the funerals of several patients and recently spoke at one. She even gives some patients her cell phone number. e intimacy she enjoys with her patients can also spill over to out- side her office. "I've had patients have all sorts of graphic conver- sations at the gas station, the dry cleaners," she says. "ey'll li up their shirts up and show you a mole." One irony of physicians becoming more open with pa- tients is that in a 2004 study, when primary care physicians disclosed information about themselves, patients were less sat- isfied with their visits and were less likely to report feeling reas- sured or comforted. But when surgeons self-disclosed, patients were more satisfied and reassured. Physicians in small towns say they have really no choice but to be close to their patients. Jen Brull, MD, is a family physician in Plainville, Kan., population 2,000. She sees her patients at her children's schools, at church and the grocery store. She lets pa- tients friend her personal page on Facebook and invites them to the 5 a.m. exercise group she attends. "If I had to separate my pa- tients and friends, I would either have no friends or no patients," she says, making her decision very simple. e relationship between patients and their physicians is a most interesting and complex subject. As boundaries shi in our modern world, walking the fine line between appropriate and inappropriate "sharing" is going to take thought and good judg- ment. For me, appropriate sharing must be enough to have the information needed to build a trusting relationship. Too oen, bureaucrats and other outside parties forget how important a personal relationship can be, they make political de- cisions that oen are detrimental to both physicians and patients. As with most clinical decision-making, how much to share — within the usual, common-sense boundaries — ought to be be- tween the doctor and the patient. n

• Cover