Female doctor uses tonometer to make blood pressure measuring to senior man

Your Doctor-Patient Relationship: Tempo, Time, Touch, and Trust

A quality doctor-patient relationship is essential.

Healthcare is a collaborative effort between the patient, the doctor, and the medical team. As a physician, I know certain things will make or break that relationship.

Today, I want to share four essential factors — the four Ts — for any doctor-patient team. You can think through each one as a kind of self-diagnosis. Is that relationship positive and productive, or do you need to make an adjustment?


How often do you need to see your doctor? This routine is like a rhythm, a tempo.

Tempo all depends on your progress and condition. If your situation is complex and we’re just getting started, you may need to meet with your doctor every week. After that, you might roll back to every two or three weeks. Once your condition is stabilized, you may only meet every three to six months.

Historically, the healthcare system hasn’t done a great job with tempo for people with chronic kidney disease (CKD). Many patients will only be seen every six months, even when their condition is steadily declining. They don’t receive significant treatment until their kidney function is so low that it’s time to go on dialysis. By then, it’s too late.

Today there are effective medications and lifestyle changes that can preserve kidney function! Nobody should have to wait for kidney failure. It’s time to take control of your health today.

Make a change: Do you have a good tempo with your doctor? Ask yourself two simple questions to find out:

  • Is your condition new or getting worse? You may need to meet with your doctor more often. Let them know that you are ready and willing to take control of your health.
  • Is your condition stable or improving? You may be able to extend your visits to every three to six months.


Regardless of how often you meet, you want to ensure you are doing something meaningful with the time with your doctor. When my patients come in, we ask how they are doing, what they need, what can be improved, and what questions they have.

Time depends on each patient and their condition. A complex patient needs much more time and attention than a stable patient who simply needs a check-in.

Many people feel like the doctor doesn’t have time for them. I hear this complaint all the time from both patients and personal friends. What’s happened here? For a variety of different reasons, the process has fallen apart. Doctors are told they must meet specific quotas, see a certain number of patients every hour, and squeeze in all their notes. Often this is a failure of our health system, not necessarily our doctors.

Make a change: How can you make the most of your time with your doctor? Come prepared for every appointment!

  • Track your vitals at home: blood sugar, blood pressure, and weight. There are many apps and devices to help you, but you also can’t go wrong with a good old-fashioned spiral notebook!
  • Bring your medication bottles to every appointment.
  • Write down your questions in advance. It’s hard to remember everything in the moment.
  • Bring a patient advocate with you. This close friend or family member can help you ask questions and remember details. They help you make the most of each appointment, even when you have limited time with your doctor.


Every time you communicate with your healthcare team is a touchpoint. This includes appointments, treatments, lab work, calls, messages, and more. Much like tempo and time, your success depends on the quality and quantity of these touch points.

One of my favorite touch points at the UT Health Science Center in San Antonio was a graph we’d show our CKD patients every time they came in. This graph shows their glomerular filtration rate (GFR) and kidney function over time. The patients love it because it illustrates the trends of where they are headed. They are extremely aware of exactly what’s going on. There’s no shock; there’s no surprise. That’s an indicator of a quality touchpoint.

A sample graph of kidney function (GFR) over time.

I personally believe that even physical touch is important for the doctor-patient relationship. Something powerful happens when a doctor touches a patient, listens to their heart and lungs, and feels their belly. It doesn’t take long to do this, but the ritual of touch reassures patients that we care — we’re involved, paying attention, and figuring it out. It reinforces the connection we have together.

Make a change: Do you feel like something is missing in your communication with your doctors? Speak up!

  • What is your communication style? Tell your doctor if you prefer phone calls, texts, or emails. If you are having trouble with a patient portal, let them know! You could be missing out on valuable information.
  • What is your doctor’s communication style? Every practice is different. Find out if they have a patient portal and how they will share lab work and results with you.


If you’re on a baseball team and don’t trust your teammates, are you going to win many games? Your healthcare providers form a team with you, and trust is just as important.

Your primary care physician (PCP) is at the center of this team, so it’s essential to find a good one. It’s their job to coordinate your specialists and make sure everyone is working in tandem. Everyone needs to speak the same language and get the same answers.

Remember that your patient advocate can also be a valuable member of this team. Your trusted support person can help you remember details, ask questions, and identify problems.

Make a change: Your doctor should put 100% into your doctor-patient relationship, and you should too! Even when you are patient and make every effort to work with your healthcare team, there may still be times when you need to get a second opinion.

  • Conflicting information: If you get conflicting information, that’s a red flag. What if your cardiologist tells you to stop a drug, but your endocrinologist tells you to take it back up? Ask your PCP to find out what’s going on. Each of your doctors should be willing to coordinate and collaborate for your health.
  • Lack of optimism and hope: There’s always something we can do. Even if you begin your kidney health journey with very low kidney function, your doctor can help you get stabilized and comfortable. Even when your doctor has to give you hard answers, they should do so with optimism and hope.
Your healthcare team supports your doctor-patient relationship.

Putting it all together

For us as doctors, tempo, time, trust, and touch are essential tests of everything we do. We’re playing a team sport here, and the patient is part of that team.

During my time at UTHC, we worked with one of the poorest Hispanic communities in San Antonio. They had very limited resources, but they were all very good, smart people. They just needed someone to take the time to listen and help them. Over the last year, we only ever had one patient who said he was not interested in learning and improving his health.

As a patient, you can take a moment to reflect today. Are your needs being met? Is your healthcare relationship effective? What needs to improve?

If you have any issues or questions, don’t hesitate to reach out to your healthcare team. Just like any relationship, it takes practice and mutual effort to get it right. You might find that a simple change can make a major difference in your health and quality of life.

Dr. Richard Gibney, Empowered Kidney Care P.C.

Dr. Richard Gibney

Dr. Richard Gibney has been in the kidney care industry for over four decades. Like many nephrologists (kidney specialists) he simply didn’t know that there were alternatives to the status quo. In 2006, a partnership with the Institute for Healthcare Improvement (IHI) inspired him to innovate. Years later, his eyes were opened by a visit about an acclaimed dialysis program in Jonkoping, Sweden. Over a four year period, Dr. Gibney led the successful transformation of 11 dialysis units in central Texas to an empowered model, serving over 500 patients with exceptional results. Staff and patients were extremely satisfied, and mortality and hospitalizations were cut in half. Today, Dr. Gibney and his specialized team of doctors, nurses, and technicians help others achieve the same empowered results.