How to Build Relationships with Patients: Lessons from bulldog lawyers, prostitutes, and even patients!
The reasonably holistic bulldog
Working as a healthcare attorney, I see infinite parallels between the health and legal professions’ adaptation to a more discriminating customer base. In law school, I was taught about client-centered lawyering. In the healthcare field, I hear about patient-centered care. But I don’t care much for either term, although I recognize them as movements in the right direction towards relationship-focused service.
It shouldn’t take a “client-centered lawyer” for the client to be heard, and for his or her goals to be placed at the center of the attorney’s work. Client priorities should govern all attorney-client relationships. Some call the client-centered lawyering approach “holistic lawyering” – although you don’t see many billboards advertising an attorney’s holistic approach, suggesting that’s not a popular moniker. Instead, most clients want an aggressive “bulldog” lawyer, who will conduct the cliché witness examination that leaves the opposing party in tears. (Fact: 39% of people name “aggressive” as one of the top three traits they seek in a lawyer, according to a study available here.)
In law school, we were also taught to steer clear of the client who wants to sue over “the principle of the matter.” (Note: These principle-of-the-matter troublemakers are some of my favorite altruistic, change-driven clients.) As the foreboding logic goes, these clients are impossible to please and will likely rebuke an attorney’s rational attempts at settlement. Meanwhile, we’re taught not to turn clients away simply because their cause is “distasteful” to us, and that our fees must be “reasonable.” How do all of these pieces fit together?
Prostitutes, politicians, and… lawyers
In a Princeton study that evaluated people’s perceptions of professions, study participants were asked to grade different professionals’ “warmth” and “competence.” Lawyers ranked equal to prostitutes on the warmth scale – below politicians and taxi drivers (and everyone else). They ranked very high in competence – suggesting that while people think their attorneys are smart, they don’t think they’re very nice.
Enter: holistic lawyering.
While lawyers are accustomed to lawyer jokes, most attorneys are actually surprised to hear that we’re so disliked as a collective profession. For law schools and legal theorists, perhaps, studies like this act as a wake-up call. Low public opinion of lawyers can’t be good for business, but it also can’t be good for clients. (Note: If you’re really interested, you can even read about a more recent study here, showing that we modulate our apparent warmth and competence depending on our audience.)
Google provides these synonyms for warmth: friendliness, geniality, cordiality, kindness, enthusiasm, energy. These are certainly not incompatible with competence, but are they clashing with the attorney’s habit of billing in 6-minute increments? Perhaps like the doctors who see a new patient every 15 minutes…? (I would describe many of my physicians as competent but lukewarm.)
Clients + Patients = People
One of my favorite descriptions of client-centered lawyering is as follows, courtesy of Professor Monroe Freedman at Hofstra Law School:
The free exercise of the client’s autonomy is essential. The lawyer is to assist clients to maximize their autonomy, and the lawyer acts unprofessionally and immorally by preempting a client’s moral decisions… In day-to-day law practice, the most common instances of amoral or immoral conduct by lawyers are those occasions in which we preempt our clients’ moral judgments. One way that occurs is when lawyers assume that the client wants us to maximize the client’s material or tactical position in every way that is legally permissible, regardless of non-legal considerations. Another way is to go forward without adequate consultation with the client about the client’s desires… A paramount aspect of client-centered lawyering is paying close attention to what the client says, according respect to the client’s desires, and, in appropriate cases, advising the client about the morality of particular courses of conduct.
This description reminds me of my slide at the American Physical Therapy Association’s Combined Sections Meeting in February which simply read:
Patients are people.
If I were presenting at a legal conference about how attorneys should approach their clients, I think I’d write:
Clients are people.
Let’s get over the individualism.
Why did we need to move from physician-driven healthcare into patient-focused care? Or from attorney-run cases to client-centered lawyering? Why are we so blind to the importance of building actual relationships with those we serve? The definition of client-centered lawyering above focuses on important aspects of a relationship: listening, advising, respecting autonomy. I would argue that such an attorney isn’t providing client-centered lawyering but, instead, focuses on building an authentic, supportive relationship with his or her client that will allow the client to feel involved in the process, understood, and heard. During my talk at CSM, a physical therapist tweeted:
— Kyle Ridgeway (@Dr_Ridge_DPT) February 19, 2016
Yeah — that’s how it’s supposed to work. Clearly, those same values resonate with healthcare providers who struggle to overcome their own sense of paternalism towards their patients. Work together on the patient’s goals, listen to their needs and priorities, and consider factors outside the realm of your clinic that may affect their recovery.
While I don’t suggest that it’s easy to implement in practice, I think the concept is simple: treat people like people. Follow the golden rule. Focus on building real relationships with those who walk through your office door, remembering that when someone is struggling, validation and understanding are one of their greatest needs.
It’s my hope that, by next February, if I’m fortunate to be invited back to CSM, a slide reading “Patients are people.” would seem obvious – much like if my slide read: “The sky is blue.” I hope that it won’t get so many photographs and hashtags, because it will be so embedded in our psyche that we’re talking about how to build these relationships, rather than the very fact that we need to build them.