Doctor-Patient Rapport

By Richard Donahue, MD

Boston is a mecca for some of the finest medical education in the country. While 20th Century medicine unraveled the complexity of cells within organs, 21st Century medicine is unraveling the medical mysteries connecting our organs; messenger hormones, reactive and protective inflammation pathways, and the neurocircuitry connecting our brain, moods and GI tract.

Specialists are gifted with treating life threatening organ diseases, with the latest technology. For example, a brain tumor or a heart attack. But nature does not yield to us that easily. 21st Century medicine sees chronic illnesses residing in the molecular signaling, the complex crosstalk between our organs, and the interplay of the environment on our genetics.

I am fascinated by how doctors think. Many specialists think about localized diseases while generalists tend to think about interconnected systems. We need a doctor with technical expertise, we want a doctor with excellent rapport, who can “tune in” to the patient. In a fascinating study where patients ranked doctors on competence and compassion, the less interpersonal doctor in a white coat was prejudged as more competent. The less formal more interpersonal physician was deemed to be less competent. Do we really have to trade-off good rapport for competence? I think our medical education system can teach rapport and competence as synergistic.

Here’s the rub – The best doctor-patient rapport leads to discovering the hidden clues, patterns in the patients story, that can yield earlier and more concise diagnoses. Perhaps we have overrated technology at the expense of the less tangible value of caring and rapport. I teach my medical students that doctor-patient rapport is like a dance, sometimes we lead and sometimes we follow, but we arrive together.

A good doctor knows their stuff, a great doctor also knows their patient well.

One measure of a physician is how they integrate new scientific thought with depth of clinical experience, medical instinct, and gestalt, to make decisions in the face of uncertainty. This I strive to attain.