Jarrod Shapiro, DPM Practice Perfect Editor Assistant Professor, Dept. of Podiatric Medicine, Surgery & Biomechanics College of Podiatric Medicine Western University of Health Sciences, St, Pomona, CA

Doctor Style

I’m not asking about whether you wear khakis or dress pants, or a polo shirt versus button down dress shirt with a tie. I’m actually asking about your patient interaction style. Clearly, the way we interact with our patients has a great deal of significance to our success in treatment. Some patients respond better to certain physician styles. When I was in training, I had a few attendings that came across so poorly I was amazed they had any patients at all. I’ve seen excellent surgical technicians who, once they left the OR, became essentially ineffective caregivers. Clearly, each one of us has our own style. Have you ever wondered, though, if your style is effective? Do patients respond to a certain style better than others?

		Tonight's Premier Lecture is Arthroscopy of the Foot and Ankle Ryan Fitzgerald, DPM

Obviously, it is difficult to pin each physician down to a specific practice style since there may be overlap, but it is possible to figure out your general practice style. Personally, I tend toward the Deliberator style.  I provide my patients with their options but do state the positives and negatives of each option, participating strongly in their choice of treatments.

Is One Style More Effective Than Others?

Has the research literature found one to be more effective than the others? One particular study³ looked at various communication patterns between physicians and patients, using physician and patient satisfaction surveys as part of their outcome measures (127 physicians and 537 patients). They found the most common styles to be an almost equal mix of the authoritarian and interpreter styles among the physicians. Interestingly, physician satisfaction was lowest in the Authoritative and highest in the Informer style, while patient satisfaction was highest in the interpreter style. These results point to patients desiring greater levels of discussion and interaction (the main characteristic of the Interpreter pattern) to the less interactive authoritarian style. Unfortunately, physicians found this style to be less satisfying. The authors explained this discrepancy by the fact that  physicians want to make better use of their time with less conversation, thereby improving their overall productivity and hence their satisfaction..

I can understand this dichotomy. Patients who are facing an unknown and uncomfortable situation often desire discussion, interaction, and understanding from the one authority they trust most – their doctor. On the other hand, the physician, already dealing with an overloaded schedule, and with a greater understanding of the clinical situation, might prefer his patients to be quiet and listen.

The Bottom Line

Here’s my realist approach. You can’t please everyone all the time. You have to choose the style most comfortable to you, realizing that if your patients want education and interaction, and you don’t provide it, they’ll likely go to someone who does. The best way to find balance is — unfortunately for you authoritarians — to get to know your patients. Interact with them and learn their social cues. Adapt your style accordingly, while being true to your personality. Counsel them in detail when they want it and be the authoritarian when they need it. It all boils down to a patient-centered approach and the utilization of some subtle judgments as to the particular needs of a patient owing to their particular clinical situation. Best wishes.

Keep writing in with your thoughts and comments. Better yet, post them in our eTalk forum.
Best wishes.

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]

References:

1. Emanuel E and Emanuel L. JAMA, April 1992; 267(16): 2221- 2226.
2. Beck R, et al. J Am Board Fam Pract, Jan 2002; 15(1): 25-38.
3. Roter D, et al. JAMA, Jan 1997; 277(4): 350-356.

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