Last month, I attended what for me was an unusual meeting at the American Medical Association’s (AMA’s) headquarters in Chicago. It was called Saving Time: Practice Innovation Boot Camp, a part of the AMA’s STEPS Forward Innovation Academy. Now, even though it was a boot camp, I did not need to bring workout gear or prepare myself for screaming drill sergeants; it wasn’t that kind of boot camp. Instead, I spent two days learning from AMA leaders about how to bring back some of the joy of medicine by adding some things (more team-based care, more personal communication), modifying some things (clinic setups focused on the physician-patient dyad, realistic schedules), and removing some things (unnecessary password entry, note bloat).
Since I spend much of my time working with healthcare leaders who are facing seemingly endless problems, I should admit that I’ve heard of and considered many of the suggestions that were presented in Chicago. However, I was caught off guard by a statement from the first speaker, Christine Sinsky, MD, MACP, the AMA’s VP of professional satisfaction. Even though I’ve been a longtime fan of her work and voluminous publishing (123 articles in the medical literature … and counting!), I hadn’t anticipated one of her first statements: “Relationships are physicians’ superpower.” Wow.
The doctor-patient relationship is the real deal, and it can’t be replicated by artificial intelligence. Some of us may pine for the Marcus Welby days when doctors made house calls and charged $1.50 for an appointment, yet those times are long gone (at least the $1.50 part!). Still, the ongoing relationship between a patient and their physician, whether for years in a primary care practice or days in an inpatient setting, makes a difference. The trust that is implicit in these connections between clinician and patient enables a coming together of the minds that allows for forward progress.
Ongoing continuity of care (a key component of relationships) isn’t just a nice-to-have, and it’s not just an opinion that these long-lasting dyads are good for all involved. Quality of care is improved via an ongoing primary care relationship (see here and here). The cost of care is decreased by seeing the same clinician over time. This makes sense when one considers what happens when a covering physician is brought into the mix: more tests, more time to get up to speed, etc. Mortality statistics are even improved when relationships are maintained (see an essential discussion from Dr. Sinsky and her colleagues here).
Beyond the patient and physician, the relationships between healthcare professionals themselves are crucial. A stable, cohesive team not only enhances patient care but also contributes positively to the work environment, reducing clinician burnout and improving job satisfaction. The magic lies in the mutual trust, emotional support, and optimized workflows that develop within well-acquainted teams (teamwork makes the dream work!). For example, when nurses, medical assistants, and physicians work together consistently, they create a synergistic effect that enhances the overall quality of care and efficiency, demonstrating the superpower of strong clinician-clinician relationships.
So, how can healthcare systems and practitioners harness this superpower and reorient healthcare around relationships? The key lies in intentional, systematic human-centered design changes that prioritize and foster connections at every level of care delivery.
Firstly, structurally prioritizing continuity of care is essential. This means reconfiguring care models to ensure that patients consistently see the same healthcare provider or team. Practices could implement systems that make it easier for patients to schedule follow-up visits with the same physician, enhancing the continuity of care. In order to allow follow-up for patients, practice managers must keep some percentage of the schedule open for these last-minute appointments. We pediatricians are pretty good at this since a huge part of our work involves seeing children who got sick that same day. Further, we should leverage electronic health records (EHRs) to make the longitudinal history easier to comprehend and engage with; less hunting around for results and more proactive display of data and trends we haven’t asked for yet.
Administrative "sludge" – the myriad of non-value-add tasks that consume healthcare professionals' time – must be addressed. By streamlining documentation, simplifying logging-in procedures, and removing unnecessary bureaucratic hurdles, physicians can reclaim time for what matters most: their patients. What is sludge, exactly? Scholars Richard Thaler and Cass Sunstein define it in their seminal book Nudge as “any aspect of choice architecture consisting of friction that makes it harder for people to obtain an outcome that will make them better off.” When physicians must re-type the history of present illness that was obtained by the rooming medical assistant, that’s sludge. When the oncology nurse isn’t permitted to update the tumor staging from the biopsy report because only the physician can do that, you’re dealing with sludge. These obstacles to relationships among clinicians decrease our ability to take care of patients.
I think Dr. Sinsky is right: When it comes to healthcare, relationships are our superpower. All of us must focus on continuity of care (both in the clinic and in the hospital) so that we reward the maintenance of relationships. Physicians and healthcare leaders must critically examine their practices and systems, seeking ways to put relationships at the center of care delivery. By doing so, they not only enhance patient care and quality but also improve their own professional satisfaction and well-being.