Building Loyalty through the Doctor-Patient Relationship

Despite a lack of formal training, I have always considered myself a good communicator. In my clinical practice, I interacted well with my patients, demonstrated empathy, and my patients seemed to like me.

One area where I needed improvement in my personal practice, however, was that I was constantly running late. It seemed that no matter what, I was consistently 30 to 45 minutes behind schedule. This could be attributed to spending extra time with my patients, but often, it was just me being late.

Despite my epidemic of tardiness, I was fortunate to achieve high patient experience scores. I often wondered why my patients were willing to give me a break in this regard, as if they were reinforcing my bad behavior. 

The answer came to me one day during one of my patient’s last visits after her full cycle of treatment for rectal cancer. “That first day, you made me feel so at ease,” she told me. “Thank you for taking care of me!”

While I was incredibly humbled by her compliment, I was also shocked. When I first met this recently diagnosed patient, I walked into the exam room an hour late and was met by her and six of her family members. Talk about being embarrassed. I had made each one of them wait!

However, I also remember that, after introducing myself, I immediately put my hand on the patient’s arm and said, “I apologize for making you wait, but I want you to know that my time is now yours and I will be with you for as long as you need.” I proceeded to meet the rest of the family. Listening with purpose, we proceeded with the appointment.

It dawned on me, when this patient thanked me, my communication and empathy towards her had more of an effect on her than my tardiness. It fulfilled her need for reassurance, and perhaps lessened some of the anxiety she was feeling about her treatment.

New research demonstrates the value of connecting with patients in a meaningful and empathic way. It points to such connections as critical drivers of patient loyalty, based on “Likelihood to Recommend” scores on patient experience surveys. The findings suggest that earning patient loyalty by improving how we communicate, both with patients and with others on the care team, improves providers’ ability to meet patients’ needs and reduce their suffering. It also helps providers earn market share in an increasingly competitive environment.

The findings also reinforce the fact that patients’ “Likelihood to Recommend” a provider or health system is more than an expression of their satisfaction with the care they received. Patients are heavily influenced by our ability to communicate, demonstrate compassion, and show empathy. In an analysis of 937,000 ambulatory encounters from the study mentioned above, 15.7 percent of patients were “not very likely” to recommend their physician or medical practice to others.

Among those who were very likely to recommend both their physician and the medical practice, the key loyalty drivers were their confidence in their provider, their perception of how well members of the healthcare team worked together, and their belief that the caregivers showed real concern for their worries. In other words, the return on physicians’ investment in establishing a meaningful connection during every encounter is great. It goes a long way in negating the impact of long wait times, cluttered waiting rooms, and parking trouble.

Although we should strive to reduce all sources of avoidable suffering every chance we get, patients evaluate us on the important things, particularly our ability to deliver and ensure compassionate, connected care.

Meeting patients’ needs for such care can be achieved by committing to excellence and:

• Setting a “patients first” philosophy in your practice. Ensuring that everyone is aligned with the philosophy to create the best possible experience for patients.

• Measuring patient sentiment and using that information to help you and your staff understand performance gaps where you are not meeting patients’ needs.

• Investing in the development of good communication skills for yourself and your staff. Just as being a good clinician requires us to learn and practice new information and skills, so does being a good communicator. Effective patient communication is a skill that can be taught, practiced, and improved. Taking the time to do so will pay off for you and your patients.

When patients are sick and seeking health care, they are often anxious, depressed, and fearful. In addition to providing high-quality clinical care, we can help alleviate their suffering by ensuring that we are paying attention to the things that matter to them. It is our duty to treat the human condition as well as the disease that brings our patients to us. We would want nothing less for ourselves or our families.

Dr. James Merlino joined Press Ganey as president and chief medical officer of the strategic consulting division in 2015. As an accomplished surgeon and industry leader in improving the patient experience, Jim draws from more than two decades of health care experience to oversee Press Ganey’s consultancy division. Under his leadership, the consultancy team helps providers improve the delivery of safe, high-quality care in a patient-centered environment. Prior to joining Press Ganey, Jim served as chief experience officer and associate chief of staff at the Cleveland Clinic health system, as well as a practicing staff colorectal surgeon at the organization’s Digestive Disease Institute.