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We are joined by Paul Pender, an ophthalmologist with extensive experience in patient care. We explore the vital role emotional intelligence plays in strengthening the physician-patient bond, particularly in challenging health care environments. Paul shares insights into how self-awareness, empathy, and relationship management enhance caregiving, build trust, and help alleviate patient suffering. We also discuss the emotional challenges physicians face, including moral injury and burnout, and how cultivating compassion-driven skills can transform patient outcomes and physician resilience.
Paul Pender is an ophthalmologist.
He discusses the KevinMD article, “Why meaningful patient connections matter in medicine.”
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back Paul Pender. He’s an ophthalmologist. Today’s KevinMD article is “Why Meaningful Patient Connections Matter in Medicine.” Paul, welcome back to the show.
Paul Pender: Hey, Kevin. Thanks for having me back.
Kevin Pho: Well, thanks again for writing. Always looking forward to hearing your insights. Today’s KevinMD article is “Why Meaningful Patient Connections Matter in Medicine.” Tell us the events that led you to write this article and then talk about the article itself for those who didn’t get a chance to read it.
Paul Pender: Sure. I’ve been reading a lot of the posts that your readers have been sending in, and I was affected by what some people had said. And so I decided to write this article about meaningful patient connections. I think the reason why it’s important is that, as a physician, you want to have a really important and intimate discussion with your patient, and they have to feel like you have their back.
So, in anticipation of this particular podcast, when you usually say, “What messages do you want to leave your audience?” I decided I would refer to my notes and get that out in front right away.
Kevin Pho: OK, so what is it that you’re trying to establish with your patient?
Paul Pender: Well, first, greet them by looking them in the eye. Nothing says more about your giving your undivided attention than eye contact. And that’s assuming your eyes don’t glass over, OK? Next is to get to know them as people. Short visits are not conducive to great relationships. New patients offer the opportunity to engage them as people who need your help. Regular follow-up visits allow for updates on family and activities besides health issues.
Some of my most enjoyable political discussions occurred with a high school science teacher who had glaucoma and was in my exam room several times a year as part of good health maintenance. Listen. Be heard. Being heard by the doctor establishes a bond. Be empathetic. Understand that their behavior may be influenced by fear of the unknown. Educate the patient on the nature of the problem and how you propose to deal with it. I used a plastic globe for demonstration purposes as an ophthalmologist.
Complete your verbal summary. When interrupted while I was summarizing, I often said, “I listened to your concerns. Now, please let me address them.” They would sometimes apologize for the interruption, but it forced them to stop and think about what I was saying, which would hopefully anticipate their questions and provide some acceptable answers.
Say when you would like to see the patient again. An acute sight-threatening condition for an ophthalmologist requires frequent follow-up, while a well-controlled problem like allergic conjunctivitis might be only seasonal. And ask if you have any questions about what we discussed—it offers a chance for the patient to express any lingering concerns.
And I say this as sort of a mindset that the doctor ought to have, because hopefully, in your encounter with the patient, the patient is going to feel like you have their best interests at heart. And so, I think those meaningful connections that are more personal and not just professional go a long way in establishing both rapport and better adherence to treatment therapy.
Kevin Pho: Now, you said that what led you to write this article was reading some other articles on KevinMD. Was there any specific theme that you picked up on that really gave you that initiative to focus on that personal and emotional connection with patients?
Paul Pender: I think the emotional part is important because, oftentimes, we know patients come in, and they might have literature searched through a webpage or something. And they come in with questions, and they may find that it’s just too confusing, or they’re very fearful. So to try to set aside some of the fear, we engage in some early banter.
And I remember one of the papers that you accepted for publication was from a doctor who had a coffee mug sitting on her desk that said, “My medical degree is not equivalent to your Google search.” That was pretty clever. And I thought, OK, people get information from a lot of different sources, but you’d like them to have the confidence in you as a physician that you’re going to give them good information.
So, there are plenty of other examples. I mean, every time I look at your page, I find that there are very interesting insights provided by both patients and physicians.
Kevin Pho: Now, today, as you know, there are so many pressures that prevent physicians from establishing those deeper connections with patients. And that’s compounded with burnout and moral injury, and I’m sure you’ve read those articles on KevinMD as well. So, given that context, how can physicians continue to show empathy, show compassion, and maintain those personal connections when more than half of them are already burnt out by the bureaucratic hassles and by the electronic medical records?
Paul Pender: Right. Yeah, there are a lot of hurdles that stand between that patient and doctor relationship, and I think it’s incumbent upon us as physicians to try to make sure you carve enough time. You know, it’s not just about the length of the visit; it’s about how engaged you are during that visit. And I think that’s also important.
Certainly, there are other types of practice models that allow for more time per visit, and some of the direct patient care models that are subscription-based allow for a smaller panel for doctors to handle but allow more time. So, you know, I mean, in corporate medicine, or at least where doctors are under the control of hospitals or private equity, there is a major push for throughput. We know that, and that doesn’t necessarily encourage these more intimate relationships with the patient.
I think doctors want to have a sense that their work is respected, and they don’t want to feel like they’re being pushed, and they don’t want to feel like their desire to reach some sort of understanding with the patient is compromised because of time limits or because of the administrator’s demands for metrics, which kind of trump the doctor’s approach to the patient’s own medical needs.
So, I think that this relationship, the doctor and the patient, really has to be nurtured. And that’s often very difficult in the current climate.
Kevin Pho: Now, you’re an ophthalmologist, and when you were practicing, sometimes those ophthalmology visits weren’t always the longest, and you would have to see patients in a very, very short period of time, right? So, how did you maintain that connection during those short times when you would have to see a lot of patients per day?
Paul Pender: Right. So, some of them would be simple encounters. A patient had a foreign body, you’d give them a drop of topical anesthetic, they’d feel instantly better, and then you’d say, “Well, now that you trust me, I can get rid of this thing for you.” And so, the people that come in from a metal shop and have foreign bodies embedded in their eye, you could take care of it. And as long as they healed up fine with their topical antibiotic, you didn’t have to see them again unless they still had redness or some other symptom.
But the patients who you’re going to see more longitudinally, like the glaucoma patients who had to come in several times a year for exams, follow-up visits for high pressure checks and other things, visual field exams, looking at the optic nerve—those patients are going to return to you. They have to feel incentivized by your own care about their situation to want to come back. And I think that’s an important thing to try to establish in these patients who are going to have chronic illness.
Kevin Pho: Now, can you tell us a story or example where a patient came to your office, obviously with an eye issue, and sometimes with an eye issue, patients are very anxious and nervous? Tell us a time when that connection that you made with the patient overcame their anxiety of coming to you.
Paul Pender: Yeah. Well, I just remember this one gentleman who came in with a bad corneal abrasion, and I said, “How did that happen to you?” He said, “I was playing with my puppy on the floor, and the dog just reached up and scratched my eye.” Well, you know, we got him through his initial episode, but because of the nature of the problem, some of this can recur in the type of erosion. Just to be technical, if the scab that forms on the cornea gets stuck to the upper lid when someone opens their eye in the morning, they could have severe pain.
So, the patient comes in with the same kind of complaint, and you have to kind of walk them back from the ledge to say that, yeah, we will be able to take care of this. But, you know, we’re going to have to give you nightly lubricants for a month or so, and you’ll have to kind of walk them through what it is that’s ultimately going to make them better, even though it might have been an initial short visit. So sometimes you just have to prepare the patient for what could occur. And I think that requires enough conversation and empathy to make sure that the patient gets it.
Kevin Pho: Now, whenever you talk to early career physicians, medical students, or residents, I just want to emphasize what you said earlier. It’s not necessarily the length of time that you spend with patients, but there are a lot of nonverbal cues that you could incorporate in the exam room that can strengthen that connection. Go over again what you think are the most important. I know you mentioned eye contact. Sometimes it’s very difficult, of course, with the computer in the exam room, but tell us about some of the nonverbal cues that physicians can use in the exam room to really strengthen that bond.
Paul Pender: Sure. The first thing you do is—I know this is tough in the COVID era—but I still shake the patient’s hand when I first meet them. We sit down, and I say, “Tell me what I can do for you today.” I mean, you give them an opening so that they can feel comfortable.
The other thing is, I think when the patient is going over their symptoms, they may be all over the place. They’re not necessarily a good historian. So, you have to let them say their piece and then try to define what it is that they are really complaining about. And then you can say, “OK, from what you described, this is what I think we need to address.”
I had, for the last five years of practice, a scribe with me in the room, and I could maintain eye contact while the patient was speaking. So someone else was doing the entry. I know that AI is being employed now to essentially record conversations between the doctor and the patient to allow for a greater ease of documentation. And that may prove to be valuable. It could be a time saver, but as one of your writers said, maybe the corporate types will stuff more patients in the time that you saved by going to AI for documentation purposes. So, that’s a two-edged sword.
But I do think that when you show you’re actively listening, the patient gets that you care, and it’s really about establishing that feeling like the doctor is really looking out for the patient’s best interest and not trying to meet some schedule demands.
Kevin Pho: So, I get a sense that health care leadership is devaluing that doctor-patient relationship. Like you said, there’s always a propensity to stuff more patients into the schedule. Are there any policy solutions? I know you mentioned subscription-based practices, but anything that physicians can do to really preserve that bond? Anything from a policy standpoint or a leadership standpoint that physicians can do to really preserve and ensure that bond continues?
Paul Pender: I think the bond is the most important thing that we have to offer as physicians, and our expertise goes a long way in helping patients who are sick get better. But they have to believe that, ultimately, you’re looking out for their best interests and not your own personal interests. And in terms of policy, the part that really strikes me is that when third parties, like health insurance companies and corporate types, are essentially dictating terms of practice, then the physicians have to keep asking for permission and get second-guessed. So that does devalue their own medical decision-making expertise.
And I think when health plans can come around in various ways to allowing doctors to actually have greater autonomy, that’s going to help their own self-image, and it’s going to help them feel like they have more direct control over the patient’s care path. Some of that’s done now with gold cards. You know, if you’re an economically credentialed doctor and you don’t use too many, you know, expensive treatments, now the health care company can look at you and your practice patterns and say, “All right, we can skip a lot of the preauthorizations for this doctor because they have demonstrated efficiency in their practice.”
OK, well, the more you can eliminate prior authorization, the happier doctors are going to be. And I think that medical leadership has been stressing this in Congress. They’ve been trying to beat on the health plans to have them come around to say, you know what, respect doctors, and you’re going to get better participation from doctors.
Kevin Pho: We’re talking to Paul Pender. He’s an ophthalmologist. Today’s KevinMD article is “Why Meaningful Patient Connections Matter in Medicine.” Paul, as always, let’s end with our take-home messages to the KevinMD audience.
Paul Pender: Well, my first message is thank you, Kevin, for allowing us this format. I really appreciate it. I think the people that you publish really have some important insights to share, and I’m going to keep being part of that audience.
Kevin Pho: Paul, as always, thank you so much for sharing your perspective and insight. Thanks again for coming on the show.
Paul Pender: Thanks for having me again, Kevin.
