patient-doctor relationship

Doctors Learning to Listen Better

In medical school, we learn the art of questioning and we are taught that the diagnosis is usually revealed in the history. Students memorize a barrage of hundreds of questions to help them narrow the wide differential diagnosis that they are working out in their heads while they talk . . . and listen.

When I teach medical students and residents in my clinic, I first demonstrate a crucial but oft neglected aspect of taking a proper history. After our patient leaves, I ask them if they noticed what I did.

Sometimes they don’t. It’s that subtle yet it can make a difference.

After greeting patients by name with a handshake (after which I clean my hands with Isagel – we practice that to an art as well), I’ll ask how they have been and what brought them to the clinic (Most of the time, they don’t say the taxi, bus or partner). At this time, I’ll let them talk uninterrupted for at least 2 minutes.

This may seem counterintuitive in a busy medical office especially if we’re running behind schedule. However, this practice can save time, enhance communication and help me make the right diagnosis.

When we plan to see a physician for a medical problem, we will formulate in our minds how that problem presented. It can be quite a detailed story that we rehearse in our minds while we are waiting for the appointment and in the minutes before we actually see the doctor.

When patient-physician interactions were observed, it was found that most physicians interrupted their patients within 2 minutes.

If I interrupt patients before they finish a few sentences, I would have derailed the telling of their story. Crucial details may be missed that may or may not be picked up in the typical medical interrogation, and without enough information, we are more likely to miss the correct diagnosis.

After my patients explain their symptoms in their own way, I’ll ask for those further details we learned so well in medical school.

Of course, not every problem or all patients need as much time to tell their story, but it’s important for the well-being of the patient and the health of the patient-doctor relationship to give that time and to take the time to listen.

patient-doctor relationship

Rushing to a Diagnosis, Doctors May Listen Less

In medical school, I learned the art of medical questioning. We didn’t realize that to the patient it can feel like an inquisition.

When the “chief complaint” (Yes. That is the medical term for a patient’s main presenting concern.) is pain. We were trained to ask, “When did it start?” “Where does it radiate?” “What makes it better?” “What makes it worse?” “Is it worse with activity?” “Is it worse after eating?” “What kind of pain is it? Sharp or dull? Colicky? Lancinating? Crampy? Squeezing?”

When the pattern of your answers to our patter of questions seems to fit the typical presentation of a clinical syndrome (i.e. gallstones, peptic ulcer disease), our questions become even more focused and specific as our differential diagnosis (the broad range of potential diagnoses) quickly narrows to one specific diagnosis.

The risk of narrowing that differential too quickly is to force the patient’s symptoms into the tight box of the diagnosis we have in mind. That may very well be the wrong one.

Next: How some doctors are learning to slow down and listen.


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What Doctors Really Think; Improving the Patient-Doctor Relationship

When dealing with doctors, many patients feel like they are treated like numbers or diseases. We all want to be seen and treated as complete individuals.

You might be surprised to hear that with very few exceptions, my medical colleagues invariably put the patient first. The individual is the focus of every clinical encounter. It is the priority of all that we do – in our daily work, at our meetings, on rounds and in lectures.

Doctors do care about your wellbeing but they don’t always show it.

Have you ever felt unappreciated in a relationship then realized that you are valued in different ways?

It’s as if men and women are from Earth and doctors are from another planet.

The truth is we start off as (and remain very fallible) human beings who are abducted and converted by an alien culture (a.k.a. medical school). Some of us have more difficulty reconnecting with our own humanity and remembering what it’s like to be a patient.

Fortunately, medical schools have been evolving over recent years with greater emphasis on communication and patient-centredness.

In upcoming posts in this series, you’ll learn about promising new initiatives to help physicians relate better to their patients. It’s something we all value. A solid patient-doctor relationship facilitates the therapeutic alliance needed to ensure the best clinical outcomes and positive experiences for both you and your physician.

This is a cornerstone of the new Burnaby Division of Family Practice, a non-profit association of the city’s family physicians. Our vision for the Burnaby community: patients and physicians achieving health and happiness.

But to improve any relationship, both sides must work together. We need your feedback. Send your comments and suggestions to me at or leave a comment on this page.

What do you like? What don’t you like? How can we do it better?

Dr. Davidicus Wong is Chair of the Burnaby Division of Family Practice. You can find his Positive Potential Medicine podcasts at

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The Patient-Doctor Relationship: The Sources of Conflict

The positive patient-doctor relationship is essential to your health, but it is often far from perfect.

The reasons for conflict and discomfort are complex. Doctors are human too with their own priorities and emotional reactions. Sometimes our styles and personalities clash. As with all our relationships, we each bring emotional baggage to the bedside.

Medical school teaches us to be dispassionate and dissociated so that we can be objective and clear-headed in an emergency. If we do this too well, we can come across as cold and clinical.

We learn a particular system of inquiry – a way of funneling down our questions from broad to narrow. When we become too focused on disease and overly task-oriented, we may seem abrupt and rushed. Doctors are known to interrupt their patients’ answers in order to ask another question!

Patients sometimes feel like they are treated like a number or a disease. They want to be seen and treated as complete individuals.

Next: You may be surprised how doctors really feel about patients.

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Understanding & Improving the Patient-Doctor Relationship

Though your doctor is the last person you should think of on Valentine’s Day, the patient-doctor relationship is one of your most important. Your health depends on it.

Ideally, it’s a relationship of mutual positive regard. You feel comfortable telling your doctor anything and everything, and you trust your doctor to give you the best care.

In turn, your doctor knows all about you, trusts you, guides you through the health care system and supports you through the highs and lows of life.

But like every other relationship, it is rarely perfect. We can have communication problems – not surprising when we are speaking two different languages: Medspeak and normal English.

Misunderstandings are common. Even when the doctor writes instructions down, they can be hard to read. You might not feel bold enough to disagree with your doctor or admit that you won’t be able to follow through with the plan. Then you may feel embarrassed to come back not having adhered to it.

If communication has been particularly bad, you may harbor negative feelings towards your doctor and perhaps all doctors. Some people never see doctors for just this reason. Of course, uncomfortable physical examinations are another.

What has been your experience with physicians? What did you like? What did you hate?

Next: How we miscommunicate.

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Achieving Your Positive Potential: 3 Keys to Success

Before you set any goal big or small, consider first your deepest values and your calling (the intersection of your talents, your passions and the needs of your world). The young parents’ calling is to nurture their children. They don’t have time to write novels or complete an MBA.

Break down your megagoal into smaller achievable goals that once achieved boost your confidence to attack the next goal.

Be prepared for obstacles and detours but don’t give up. Be flexible with your goals. When the unexpected happens, you may have to change your strategy mid-game. That’s all part of the game of life.

The third key to success is (3) support. To make it to the finish line, we need trailblazers (The mentors, trainers and health care professionals who help pave the way for us), we need our fans (our friends and family at home and at work to support and cheer us on) and teammates (travelling companions on the same path). They are like members of a cycling team streamlining, taking turns at the lead to pull the others ahead.

Change is inevitable so we all ought to be agents for positive change. Focus on your values, set your goals and achieve your positive potential.

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What’s Your Resolve? How to Achieve Your Goals

Some of us don’t bother with either resolutions or goals. We go about our days and do what absolutely has to be done – sometimes at the last minute, sometimes too late – and leave the rest for later (or someone else).

Some of us set goals – like quitting smoking, joining a new exercise program or eating a healthier diet but just can’t get started. Sometimes we start off great but get sidelined by unexpected obstacles.

A few have been successful at meeting many of the goals they have set. The first two keys to their success are (1) motivation (They chose the right goals for themselves – what they cared about) and (2) planning (They achieved a number of incremental goals. You can’t get to the peak of the mountain in one giant leap. Each step will bring you closer, and each step closer increases your confidence and sense of achievement).

Next: The Keys to Success & Achieving Your Positive Potential

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Chinese New Year Resolutions: A Second Chance for Procrastinators

I think of the Chinese New Year as another crack at New Year’s resolutions for those who procrastinate. This includes all of us because after all, we all put something off. Though we’ve paid the bills, got enough insurance, fed the kids and bought the groceries, we may not have kept in touch with all of our friends, stuck to the best diet, become as fit as we can be and exhausted our bucket list. There’s always something we should or want to do but somehow never find the time.

Of course, some are better at putting things off than others. Married men tend to have longer procrastination lists. That’s not because they are any less organized or capable than anyone else. When someone else is adding extra duties to your to-do list, it’s harder to take ownership and commit to those extra tasks.

That’s not unlike the fate of many “doctors’ orders.” When we set goals that a patient doesn’t embrace, we shouldn’t expect them to achieve them. What would you do if someone who doesn’t live in your home tells you to lose a few inches, exercise more, take some new pills and give up your favourite pleasures?

Coming up: What is your resolve?


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The Ritual of the Day’s Review

One of my cures for insomnia is my nightly ritual of the day’s review.

Making peace with each day – your activities, conversations, emotions and thoughts – is one means of seizing the day before it flows into the next.

If you do this well, it can help you sleep more soundly, leaving less unfinished business for your subconscious and less worry for your conscious mind.

It can make you more conscious of the dynamics of your thoughts, emotions and relationships.

Your nightly questions can inform how you live each succeeding day. I have several approaches. With all of them, you have to go to bed early enough so that you don’t fall asleep before a moment of reflection.

1. Simply review your day from the moment you awoke. What did I do? What were my thoughts? What did I feel at different points throughout the day?

2. Review seven questions. These are the same questions I use in meditation. What am I feeling (What did I feel throughout the day?)? What am I thinking (What were my thoughts and preoccupations?)? What am I doing (What did I do? Were my actions aligned with my values?)? What am I saying (What did I say?)? What do I see (What did I see? How did I see others?)? How am I relating (How did I relate to the people in my life this day? How did I express love and compassion?)? Who am I?

3. Focus on gratitude. What are you thankful for today? What surprises made your day? Who helped you? What were you able to accomplish?

4. Focus on growth. What did I learn today? What did I learn about others, myself and life. Without asking yourself the right questions, you may not learn as well. I call this Socratic self-questioning.

5. Focus on relationships. What important conversations did I have today? Were any transformative to either of us or our relationship? If there was conflict, what were the underlying issues and meaning? Reflect from the perspective of your whole relationship with that person and from the perspective of what the other represents to you. Who did I help? How did I express love? What did I do to nurture my relationships?

6. Focus on joy. At what points did time stand still? When did I laugh? When did I experience peace, wonder and joy?

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Forgiveness and Meaning in Your Life

There is meaning in our lives – the journey of the ego – and our relationships. The ego is not just an accident or consequence of our physical selves in this life.

There is a positive potential in the complex life we are given. Our gifts, challenges, predispositions and circumstances point towards that potential. This is the challenge and adventure of this lifetime.

In our relationships lies greater meaning also awaiting our discovery. It may be a greater understanding of others and ourselves, the issues we must resolve in order to grow – our personal demons and recurring interpersonal issues. It may be the awakening of compassion in yourself and others. It may be receiving, accepting and giving authentic love.

This is not the denial of your ego and the role of your self in this life. You must attend to the well-being and balanced health of the self so that you can achieve your potential and discover your purpose in this life.

Forgiveness involves seeing the past and our relationships from a spiritual perspective – from the vantage of real love.

It does not require your self to remain in harm’s way. Be compassionate and loving to your self.