How Important is the patient-physician relationship in neurosurgery?

Thought-provoking piece on the benefits of meaningful patient engagement in the field of neurosurgery

How important is the patient-physician relationship in neurosurgery?
 
Katriel E. Lee, BA; Rebecca M. Garner, MD
 
Medical students are constantly reminded of the supreme importance of a good patient-physician relationship, of sitting down with a patient and truly connecting by using a combination of emotional awareness and clinical skill. However, one patient in a family practice clinic claimed, “My surgeon had no bedside manner whatsoever, but that isn’t what I am looking for in a surgeon. I am looking for intelligence and skill.” A different patient explained how important it was that her surgeon was kind and willing to spend time with her while in the hospital. These contrasting encounters pushed us to address the question: how important is the patient-physician relationship in neurosurgery?
 
The literature supports the importance of good bedside manner and how it can facilitate a better patient-physician relationship and post-operative experience. A review of health outcomes and patient communication amongst all medical specialties revealed better symptom resolution, pain control, functional status, and physiological status with good patient-physician communication.1 Patients are more likely to select and refer to a spine surgeon depending on bedside manner.2 Malpractice claims can also be mitigated by better patient-physician communication.3 Overall, facilitating a healthy patient-physician relationship can benefit both the patients and ourselves.
 
Anecdotally, we have seen the beneficial effects of a strong patient-physician relationship. Patients who had more trust in their surgeon followed post-operative recommendations more closely. Additionally, the therapeutic alliances we have witnessed tended to facilitate an open and honest view of prognosis while guiding next steps in management. For example, one patient being seen for a follow-up visit after a posterior lumbar interbody fusion was experiencing increasing, excruciating back pain despite no clear cause of the pain upon initial review of MRI and X-rays. However, due to the surgeon’s ability to relate to his patient and understand what this patient’s baseline was, he was driven to re-assess the images and spot the subtle finding that he ultimately corrected with an additional surgery. This operative decision was influenced by a knowledge of this particular patient’s pain tolerance, social history, and emotional affect, all of which stemmed from meaningful patient interaction.
 
Surgical specialties have historically spent less time relative to their colleagues in non-surgical specialties on training specific to the patient-physician relationship.4 Despite this, neurosurgery is no exception to the rule that a good patient-physician relationship can improve patient outcomes, increase patient referrals, and minimize litigation. One study has indicated neurosurgeons could improve the patient-physician relationship by sitting, rather than standing while talking to patients. Patients in the study reported higher satisfaction and understanding of care when the neurosurgeon sat, despite the fact that there was no significant difference in the time spent with patients.5 This shows that there are ways in which we can improve bedside manner despite the time constraints inherent to the specialty, even if it may be as subtle as a shift in body language.
 
Throughout medical training, we have been fortunate to work with neurosurgeons who put patients first, and the positive impact on patients is clear. Meaningful patient engagement is vital in neurosurgery, especially given the gravity of disease for patients and their families.
 
 
Authors:
 
Katriel E. Lee, BA, is a Class of 2021 M.D. Candidate at the Wake Forest School of Medicine.
 
Rebecca M. Garner, MD, graduated from the Wake Forest School of Medicine in 2020 and is now completing her neurosurgery residency training at the University of Cincinnati.

The authors would like to acknowledge Charles L. Branch Jr., MD, FAANS, Chair of Wake Forest Department of Neurosurgery, for his continuous examples of excellent bedside manner, which contributed to this article.

Conflict of Interest:
The authors have no conflicts of interest to report.
 
References:
 
1. Stewart, M. A. Effective physician-patient communication and health outcomes: a review. CMAJ: Canadian Medical Association Journal. 1995;152(9);1423–1433.
 
2. Hijji, F. Y., Narain, A. S., Haws, B. E., Witiw, C. D., et. al. Variation in Spine Surgeon Selection Criteria Between Neurosurgery and Orthopedic Surgery Patients. Clinical Spine Surgery. 2018;31(2);E127–E132.
 
3. Shapiro, R. S., Simpson, D. E., Lawrence, S. L., et. al. A survey of sued and nonsued physicians and suing patients. Archives of Internal Medicine. 1989;149(10);2190–2196.
 
4. Lefevre, F. V., Waters, T. M., & Budetti, P. P. A survey of physician training programs in risk management and communication skills for malpractice prevention. The Journal of Law, Medicine & Ethics: A Journal of the American Society of Law, Medicine & Ethics. 2000;28(3);258–266.
 
5. Swayden, K. J., Anderson, K. K., Connelly, et. al. Effect of sitting vs. standing on perception of provider time at bedside: a pilot study. Patient Education and Counseling. 2012;86(2);166–171.