To rebuild a patient-clinician relationship, apologize and acknowledge your patient’s feelings.
The afternoon clinic hums with life. Behind the nursing desk, I’m rapidly shuffling papers, searching for the right chart. My clinical assistant stands beside me, reading vital signs off her clipboard.
My pager goes off and my hand moves reflexively to the silence button. Another consult. It’s 5 PM. Guess I’ll be missing family dinner for the third time this week. I toss out my cold coffee, rush into my next clinic room, and sit down.
“Good afternoon, Mr. Bauer!” I say breathlessly, turning to a fresh page in his chart. “I hear your blood pressure was a bit high today, let’s see if we can sort that out for you!”
Silence on his end. I rummage around my pocket for a pen and write the date at the top of my page. When the quiet continues for a few more beats, I look up to see a furrowed brow and a flash of anger in his eyes.
“I’ve been waiting to see you for two hours and you can’t even get my name right?” he snaps.
Oh. Not Mr. Baeur. This is Mr. Legler. Right patient, wrong chart. An innocent mistake, but one that I should’ve caught several minutes ago, not after settling in and writing the date. In a split second, our encounter has gone from neutral to sour. What I do next will shape my relationship with Mr. Legler for the rest of our time together and could directly affect his health.
Here are 5 steps to repair a therapeutic relationship:
1. Take a breath.
In the moments after a challenging encounter, it’s crucial to pause, slow down, and refocus. In Dr. Vivek Murthy’s “Together,” he describes being taught by a renowned staff physician who would stop at the door before each patient encounter and take a single and slow breath. As he developed his own bedside manner, Dr. Murthy incorporated breath into his practice. It was an easy and effective way to clear his mind and center his attention on the person in front of him. This pause also helps us to be more reflective and intentional with our next words.
2. Apologize if needed.
When appropriate, an apology can be a powerful way to heal a therapeutic relationship. Physician apologies have been shown to reduce negative emotional reactions, restore trust, and improve a patient’s expectations for positive future encounters. In this case I apologized to Mr. Legler for calling him the wrong name and keeping him waiting.
It can be helpful to put words to the unspoken feelings in the room by saying something as simple as, “I sensed some tension in our last encounter, and I want to talk about it. With Mr. Legler, I said, “Our conversation didn’t start how I hoped, but I really want to help you feel better.” By communicating a desire to improve the situation, you also shift the focus from the conflict towards a common goal.
4. Reflect on hidden factors.
Sometimes, there’s no obvious reason that a clinical encounter goes wrong. In such cases, looking at the hidden factors can help. Remember that there’s an intrinsic power dynamic that makes patients vulnerable. They may also be in an unfamiliar location or experiencing physical discomfort from their symptoms. At the same time, clinicians feel the pressures of limited time, other sick patients, and possibly concerns in their personal lives. In her book “What Patients Say, What Doctors Hear,” Dr. Danielle Ofri explains that physicians can communicate more effectively if they recognize these underlying factors and put the encounter in context from the start. She emphasizes that it’s a clinicians’s responsibility to ensure that the patient’s story is heard. The risk of a strained therapeutic relationship could be a missed diagnosis, loss to follow-up, and other negative health outcomes.
5. Empower your patient.
To create safety in the next part of the encounter, empower patients to lead the way. For example, you could give them a choice: ‘do you want to discuss your test results first, or talk about how you have been feeling?’ Sometimes, it can be enough to say, “Whenever you are ready to talk, I am listening.” With every positive interaction you share, the therapeutic relationship will continue to heal.