Steven H. Moffic, MD

Before modern medications and managed care, we tended to focus more on our relationships with patients. The goal was to establish a therapeutic alliance. Perhaps the idea of this kind of physician-patient relationship was what philosopher Martin Buber described as the “I-Thou” interaction. Instead of the “I-It” relationship where we mainly look at reducing symptoms, “I-Thou” recognizes the authenticity of the other and recommends reciprocity and respect.¹

After Buber, research found that a positive and hopeful relationship is a common ingredient of successful psychotherapy of any theoretical persuasion and technique.² Because the therapeutic alliance is crucial even during a brief medication check—and likely will enhance compliance—maybe we need to bring Buber back into prominence. Here’s how:

The nature of our work. Shortened time and reliance on medication can make us feel as if we are doing factory work. Think of psychiatry as much as a calling as a career.

The greeting. One of the most rewarding clinical experiences I’ve had occurred when a new patient came into my office. Before I could ask how she was feeling about seeing a new psychiatrist, she quickly said how pleased she was that I was her physician. Thinking that she might have looked up some of my writings on the Internet, I asked her why. She said that she had noticed that I smiled when I greeted my patients in the waiting room, as if I was happy to see them.

Look at your patient, not your computer. When my practice was transferring from paper to electronic records, I tried to talk to patients as I typed. One patient joked, “Hey, Doc, who are you talking to on that computer?” I got the message. I used to be able to scribble notes as we talked. Now, I maintain eye contact when I begin the session, and leave the computer until the end.

Know who your patients are. Find out what is most important to each patient, and refer to it often. What gives meaning to patients’ lives despite their psychiatric disorder will give meaning to your relationship.

You’re in this together. Make clear the limitations you are working under. Indicate that despite these obstacles, you will do whatever you can as a partnership. You may even want to apologize at times for what you can’t do, but would like to.

Saying goodbye. Always leave time for questions. Given the trend for less frequent appointments, which can make patients feel rejected, ask them if coming back at a later date seems acceptable. Let your patients know you look forward to seeing them again. Be sure to close with a handshake or other culturally appropriate gesture.

Disclosure

Dr. Moffic reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.

Before modern medications and managed care, we tended to focus more on our relationships with patients. The goal was to establish a therapeutic alliance. Perhaps the idea of this kind of physician-patient relationship was what philosopher Martin Buber described as the “I-Thou” interaction. Instead of the “I-It” relationship where we mainly look at reducing symptoms, “I-Thou” recognizes the authenticity of the other and recommends reciprocity and respect.¹

After Buber, research found that a positive and hopeful relationship is a common ingredient of successful psychotherapy of any theoretical persuasion and technique.² Because the therapeutic alliance is crucial even during a brief medication check—and likely will enhance compliance—maybe we need to bring Buber back into prominence. Here’s how:

The nature of our work. Shortened time and reliance on medication can make us feel as if we are doing factory work. Think of psychiatry as much as a calling as a career.

The greeting. One of the most rewarding clinical experiences I’ve had occurred when a new patient came into my office. Before I could ask how she was feeling about seeing a new psychiatrist, she quickly said how pleased she was that I was her physician. Thinking that she might have looked up some of my writings on the Internet, I asked her why. She said that she had noticed that I smiled when I greeted my patients in the waiting room, as if I was happy to see them.

Look at your patient, not your computer. When my practice was transferring from paper to electronic records, I tried to talk to patients as I typed. One patient joked, “Hey, Doc, who are you talking to on that computer?” I got the message. I used to be able to scribble notes as we talked. Now, I maintain eye contact when I begin the session, and leave the computer until the end.

Know who your patients are. Find out what is most important to each patient, and refer to it often. What gives meaning to patients’ lives despite their psychiatric disorder will give meaning to your relationship.

You’re in this together. Make clear the limitations you are working under. Indicate that despite these obstacles, you will do whatever you can as a partnership. You may even want to apologize at times for what you can’t do, but would like to.

Saying goodbye. Always leave time for questions. Given the trend for less frequent appointments, which can make patients feel rejected, ask them if coming back at a later date seems acceptable. Let your patients know you look forward to seeing them again. Be sure to close with a handshake or other culturally appropriate gesture.

Disclosure

Dr. Moffic reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.

Before modern medications and managed care, we tended to focus more on our relationships with patients. The goal was to establish a therapeutic alliance. Perhaps the idea of this kind of physician-patient relationship was what philosopher Martin Buber described as the “I-Thou” interaction. Instead of the “I-It” relationship where we mainly look at reducing symptoms, “I-Thou” recognizes the authenticity of the other and recommends reciprocity and respect.¹

After Buber, research found that a positive and hopeful relationship is a common ingredient of successful psychotherapy of any theoretical persuasion and technique.² Because the therapeutic alliance is crucial even during a brief medication check—and likely will enhance compliance—maybe we need to bring Buber back into prominence. Here’s how:

The nature of our work. Shortened time and reliance on medication can make us feel as if we are doing factory work. Think of psychiatry as much as a calling as a career.

The greeting. One of the most rewarding clinical experiences I’ve had occurred when a new patient came into my office. Before I could ask how she was feeling about seeing a new psychiatrist, she quickly said how pleased she was that I was her physician. Thinking that she might have looked up some of my writings on the Internet, I asked her why. She said that she had noticed that I smiled when I greeted my patients in the waiting room, as if I was happy to see them.

Look at your patient, not your computer. When my practice was transferring from paper to electronic records, I tried to talk to patients as I typed. One patient joked, “Hey, Doc, who are you talking to on that computer?” I got the message. I used to be able to scribble notes as we talked. Now, I maintain eye contact when I begin the session, and leave the computer until the end.

Know who your patients are. Find out what is most important to each patient, and refer to it often. What gives meaning to patients’ lives despite their psychiatric disorder will give meaning to your relationship.

You’re in this together. Make clear the limitations you are working under. Indicate that despite these obstacles, you will do whatever you can as a partnership. You may even want to apologize at times for what you can’t do, but would like to.

Saying goodbye. Always leave time for questions. Given the trend for less frequent appointments, which can make patients feel rejected, ask them if coming back at a later date seems acceptable. Let your patients know you look forward to seeing them again. Be sure to close with a handshake or other culturally appropriate gesture.

Disclosure

Dr. Moffic reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.

With today’s practice environment, most patient visits are limited to 15 minutes. Make the most of that time with the patient by following these guidelines organized by the mnemonic MEDCHECK. Try to cover all eight guidelines during each appointment, even if briefly.

Medication. Begin with an open-ended question to elicit the patient’s thoughts on his or her treatment, such as, “How’s the medication working for you?” Also ask what he or she expects to accomplish during the session. With the patient’s permission, get the family’s perspective on how the patient is doing.

Environmental changes. Learn about events in your patient’s life and how he or she is coping with them. Try to uncover information about stressors—such as a new job—or positive changes such as an old friend returning to the area. Finding a topic that the patient likes to talk about—a favorite activity or television show, for example—can help monitor improvement over time.

Diagnoses. Continually reassess the primary diagnosis and look for evidence of a medical illness, medication side effects, or secondary psychiatric conditions—especially alcohol or drug abuse.

Coordination of care. Update the patient’s file on dealings with therapists, case managers, and other physicians.

Handouts. Provide handouts and/or Web sites describing a medication’s therapeutic and side effects. Get handouts from numerous sources or develop information sheets and adapt them to your patient population. Include generic and brand names of medications to avoid confusion.

Empathy. Conveying empathy for the patient’s problems or pleasures is crucial to a strong therapeutic alliance and effective treatment.

Costs. Don’t ignore medication costs. Being up-to-date on formulary options helps patients get needed prescriptions.

Knowledge. End the session by asking the patient to summarize the medication plan to ensure that he or she knows what to do.

The MEDCHECK guidelines do not take into account necessary tasks outside of the session:

• Schedule time before your appointments to review charts and recall information from a patient’s last visit. If you cannot update the chart during the visit, reserve a few minutes later for documentation.
  
• Take periodic breaks to return phone calls or e-mails or take a short walk.
  
• Read up on relevant treatment guidelines to ensure you are providing evidence-based care.
  
• Finally, reserve time to be an advocate for your patient by addressing any administrative short-comings or removing obstacles to therapeutic recommendations.
  

Of course, short visits are not appropriate for all patients. Give more time to patients in crisis or to complicated cases such as children, pregnant women, or those needing interpreters.

With today’s practice environment, most patient visits are limited to 15 minutes. Make the most of that time with the patient by following these guidelines organized by the mnemonic MEDCHECK. Try to cover all eight guidelines during each appointment, even if briefly.

Medication. Begin with an open-ended question to elicit the patient’s thoughts on his or her treatment, such as, “How’s the medication working for you?” Also ask what he or she expects to accomplish during the session. With the patient’s permission, get the family’s perspective on how the patient is doing.

Environmental changes. Learn about events in your patient’s life and how he or she is coping with them. Try to uncover information about stressors—such as a new job—or positive changes such as an old friend returning to the area. Finding a topic that the patient likes to talk about—a favorite activity or television show, for example—can help monitor improvement over time.

Diagnoses. Continually reassess the primary diagnosis and look for evidence of a medical illness, medication side effects, or secondary psychiatric conditions—especially alcohol or drug abuse.

Coordination of care. Update the patient’s file on dealings with therapists, case managers, and other physicians.

Handouts. Provide handouts and/or Web sites describing a medication’s therapeutic and side effects. Get handouts from numerous sources or develop information sheets and adapt them to your patient population. Include generic and brand names of medications to avoid confusion.

Empathy. Conveying empathy for the patient’s problems or pleasures is crucial to a strong therapeutic alliance and effective treatment.

Costs. Don’t ignore medication costs. Being up-to-date on formulary options helps patients get needed prescriptions.

Knowledge. End the session by asking the patient to summarize the medication plan to ensure that he or she knows what to do.

The MEDCHECK guidelines do not take into account necessary tasks outside of the session:

• Schedule time before your appointments to review charts and recall information from a patient’s last visit. If you cannot update the chart during the visit, reserve a few minutes later for documentation.
  
• Take periodic breaks to return phone calls or e-mails or take a short walk.
  
• Read up on relevant treatment guidelines to ensure you are providing evidence-based care.
  
• Finally, reserve time to be an advocate for your patient by addressing any administrative short-comings or removing obstacles to therapeutic recommendations.
  

Of course, short visits are not appropriate for all patients. Give more time to patients in crisis or to complicated cases such as children, pregnant women, or those needing interpreters.

With today’s practice environment, most patient visits are limited to 15 minutes. Make the most of that time with the patient by following these guidelines organized by the mnemonic MEDCHECK. Try to cover all eight guidelines during each appointment, even if briefly.

Medication. Begin with an open-ended question to elicit the patient’s thoughts on his or her treatment, such as, “How’s the medication working for you?” Also ask what he or she expects to accomplish during the session. With the patient’s permission, get the family’s perspective on how the patient is doing.

Environmental changes. Learn about events in your patient’s life and how he or she is coping with them. Try to uncover information about stressors—such as a new job—or positive changes such as an old friend returning to the area. Finding a topic that the patient likes to talk about—a favorite activity or television show, for example—can help monitor improvement over time.

Diagnoses. Continually reassess the primary diagnosis and look for evidence of a medical illness, medication side effects, or secondary psychiatric conditions—especially alcohol or drug abuse.

Coordination of care. Update the patient’s file on dealings with therapists, case managers, and other physicians.

Handouts. Provide handouts and/or Web sites describing a medication’s therapeutic and side effects. Get handouts from numerous sources or develop information sheets and adapt them to your patient population. Include generic and brand names of medications to avoid confusion.

Empathy. Conveying empathy for the patient’s problems or pleasures is crucial to a strong therapeutic alliance and effective treatment.

Costs. Don’t ignore medication costs. Being up-to-date on formulary options helps patients get needed prescriptions.

Knowledge. End the session by asking the patient to summarize the medication plan to ensure that he or she knows what to do.

The MEDCHECK guidelines do not take into account necessary tasks outside of the session:

• Schedule time before your appointments to review charts and recall information from a patient’s last visit. If you cannot update the chart during the visit, reserve a few minutes later for documentation.
  
• Take periodic breaks to return phone calls or e-mails or take a short walk.
  
• Read up on relevant treatment guidelines to ensure you are providing evidence-based care.
  
• Finally, reserve time to be an advocate for your patient by addressing any administrative short-comings or removing obstacles to therapeutic recommendations.
  

Of course, short visits are not appropriate for all patients. Give more time to patients in crisis or to complicated cases such as children, pregnant women, or those needing interpreters.