The road to the doctor is often, unfortunately, littered with disruptive potholes.

Unpleasant, brief encounters with physician extenders (from greeters to phlebotomists to nursing assistants, clerks and insurance representatives) can make the journey to the doctor more painful than it has to be. These micro, interpersonal encounters can sour the tone, depress the mood and decrease patient compliance. Micro Relationship experiences (brief encounters with medical staff) are an important part of the culture and environment of the doctor's office, the clinic and the hospital.

And these encounters are plentiful. If in a doctor's office five staff see 32 patients a day for a five day week, in a month there would be 640 encounters (5 X 32 X 4). Multiply that times 12 months and in a year there are 7680 opportunities for a helpful or disruptive interpersonal encounter. And that does not count the long relationship experience with the doctor.

As a practicing, clinical psychologist with a focus on helping with the psychological recovery from trauma, I have been amazed when, for example, accident survivors report the plethora of medical and surgical experiences that they had had to end only to stop to express strong and thinking emotions over what we might think of as a benign event. For example, both a physician dying from cancer, treated in his own hospital and a nursing student familiar with the small county hospital to which she was taken after a vehicle accident, found it unconscionable to think that they were left in a corridor, alone on a gurney, awaiting radiology. Being left alone, having to wait, with staff apparently unaware of their anxiety, appeared to be a breach of trust and insensitivity to their discomfort. From all they had been through, this is what they remembered and sacrificed about, because it appeared to them insult to injury.

Patients of all types come for care feeling anxious and vulnerable. In this state they are more easily hurt. Just to phone the doctor's office raises anxiety. So is it a wonder that they might feel it punishment to be put on hold rather abruptly, to encounter a tired and crabby clerk taking the call, to be told they could not be helped because the doctor's schedule was very full or to be not allowed to talk to the doctor. It does not take much to go from anxious to very annoyed to angry. One of my patients, after holding for an especially long time on her land line, decided to call on her cell phone while waiting. She discovered that the office had closed and forgotten her! She changed doctors.

Waiting seems to be part of a medical-care culture that says “Expect to wait. In truth, it is not only wasted time, but wasted fees for the doctor. A post-operative lung cancer patient reported waiting over an hour and a half to see the surgeon at his office. After the first half hour, the patient asked the office staff how long was the delay going to be. Repeatedly he was told “Not much longer.” It became an apparent lie by the time he was finally brought back. There was a good reason for the delay, which the surgeon provided, but the sting of being treated as if he could not handle the truth stayed with him. Staff should never treat a patient as if he can not figure out the truth.

Efficiency is a high value in medical care. There are many patients to be seen, limited time and incentives to drive down costs and to drive up revenue. Staff doing the same thing hundreds of times become robots – they speak in a mechanical monotone and impersonal way. The patient feels like a number. The staff seem numb to the “personal” in interpersonal. The experience of the care would improve if staff could refresh and approach each encounter as if it were the only one of the day and the most important. It is for the patient.

Pleasant Micro Relationship guests are easier on the staff as well. Staff stress will decrease if interactions are positive and if the staff is then treated as if the patient is glad to see them and is ready to cooperate and appreciates the care.

To summarize:

• No brief, medical care encounter is trivial: Micro Relationship ™ experiences are lasting.
• The high frequency of brief encounters is surprising.
• In the midst of very large and painful procedures, small annoyances can play an important role.
• The culture of waiting may set the patient up for an emotionally troublesome event.
• The goal of efficiency may encourage the staff to treat the patient in a robotic way.
• Positive patient-staff encounters will reduce staff stress.
• Positive brief, staff-patient experiences will improve patient satisfaction scores and patient compliance.

Contact Information. Dr. Ralph Schillace is a practicing clinical psychologist in Rochester Hills, Michigan. He is an Emeritus Professor of Psychology, an author (“Relationship Pain”, iUniverse, 2000), a keynote speaker and consultant. His training program for medical staff presented with Dr. Patricia Reiss is entitled “Every Patient Contact Counts” which is also keynotes. He also speaks on “The Powerful Impact of Positive Feedback”.