How to improve the doctor-patient relationship

Researchers now understand a patient needs two things for any kind of health treatment to be successful. And these two requirements have very little to do with the treatment itself.

First, the patient must expect that the treatment will actually help them. This finding is interesting. It means even the most “proven” treatment in the world won’t work as well as it “should” if the patient doesn’t believe it will work. Conversely, a weak treatment often translates into a better outcome if the patient believes in it. Antidepressant drugs perfectly illustrate this point.

Second, the doctor must have empathy for the patient. I’ll tell you more about the importance of empathy in a moment. But first, let’s look at the main factor that disrupts effective medical care…


Doctors are people too. They have families and personal lives. But they are besieged by paperwork from the government, insurance companies, and other bureaucracies. This paperwork doesn’t help the patient or the doctor. And it detracts from the effectiveness of medical care.

In a new study published in the International Journal of Health Services, researchers analyzed data for 4,720 U.S. physicians. Turns out, the average doctor spends 8.7 hours per week–or 16 percent of his or her working hours–on bureaucratic paperwork. And internists and general/family practitioners spend more of their time–about 17 percent–on paperwork. For part-time physicians, the percentage is even higher.

The size of a doctor’s practice also makes a difference. As you might expect, solo practitioners spend the most time on paperwork. Doctors who work in small group practices spend 16 percent of their time on paperwork. And doctors who work in large groups of 100 or more doctors spend 20 percent of their time on it.

These outrageous numbers don’t even include paperwork relating to actual patient care, such as writing notes in medical charts, conferring with other doctors, or ordering tests. It only refers to bureaucratic paperwork, such as billing, getting insurance approvals, financial management, and negotiating contracts. So essentially, doctors waste more than one full day per week on meaningless, unfulfilling paperwork. And–not surprisingly, the more time spent on it, the less satisfaction for the doctor and the patient.

This nightmare perfectly describes the days I spent as Director of the Center for Integrative Medicine at Thomas Jefferson Hospital 10 years ago. The time I spent as a financial manager, contract negotiator, landlord, facility planner, fundraiser, government relations, and human resources specialist completely overshadowed the time I spent with patients, conferring with other doctors, or giving actual medical care and patient information.

So it comes as no surprise to me that doctors who spend more time on paperwork are less satisfied with their work. Highly satisfied physicians spend an average 16 percent of their time on paperwork. But very unhappy physicians spend an average 21 percent of their time on it. And, as you know, unhappy doctors lead to unhappy patients.

Perhaps equally concerning is the waste all this paperwork creates. The study’s authors estimate that the millions of physician hours wasted on paperwork will cost $102 billion in 2014 alone.

Now–back to the second important factor patients need for treatment success: doctor empathy. Without a doubt, doctors must empathize with their patients for the treatment to work.

My colleague and friend from Jefferson University Mohammadreza Hojat presented his latest findings on the importance of doctor empathy at the American Osteopathic Association’s 2014 annual meeting.

Dr. Hojat said empathy is not just sympathy, which entails an emotional connection to the patient’s pain and suffering. Empathy is a more intellectual understanding of the kind of situation the patient is experiencing. He also developed a seven-point empathy scale that I first published back in 2003, in the first issue of my quarterly review journal, Seminars in Integrative Medicine.

Doctors who receive higher empathy scores also receive higher evaluations in clinical competence. In addition, the patients of these empathetic doctors are more likely to experience better outcomes.

Doctors who rate higher in empathy seem naturally drawn to medical specialties that involve direct patient interaction. On the other hand, doctors with lower empathy scores seem drawn to work in hospital-based specialties, such as radiology, laboratory medicine, or procedure-oriented specialties like surgery.

Fortunately, no matter their specialty, doctors can learn to feel and express empathy. And many forward-thinking medical schools have begun to add empathy training. However, Dr. Hojat found that older doctors don’t retain this teaching over time.

So they must relearn it.

In my opinion, continuing education for physicians should always involve empathy training–not just training in new technical procedures. (Empathy may even help these doctors deal with the burdens of all the wasteful paperwork.)

As the famous18th century English philosopher, Samuel Johnson said, “mankind needs less to be instructed, than to be reminded.”


  1. “Administrative work consumes one-sixth of U.S. physicians’ time and erodes their morale, researchers say. Physicians for a National Health Program.( 10/23/ 2014
  1. “Administrative work consumes one-sixth of U.S. physicians’ working hours and lowers their career satisfaction,” Int J Health Serv 2014;44
  1. “Empathy in the realm of evidence-based medicine,” Int J Med Educ 2014;5:73-81