How to Communicate with Patients
Reminder for the busy Physician
Medical professionals debate the best strategies for the effective communication, as well as the ability of these strategies to be taught or evaluated objectively. Certainly, each physician must develop his or her own style of communication. At the same time, many professional and academic organizations have now also defined key elements of communications skills needed by physicians. For example. the Accreditation Council for Graduate Medical Education recommends that physicians become competent in five key communication skills: (1) listening effectively; 2) eliciting information using effective questioning skills; 3) providing information using effective explanatory skills; 4) counseling and educating patients; and 5) making informed decisions based on patient information and preference.
Assess What the Patient Already Knows
Before providing information, find out what the patient already knows about his or her condition. Many times, other physicians or health care providers have already communicated information to the patient, which can have the effect of coloring patient perceptions and perhaps even causing confusion when new information is introduced.
Assess What the Patient Wants to Know
Not all patients with the same diagnosis want the same level of detail in the information offered about their condition or treatment. Studies have categorized patients on a continuum of information-seeking behavior, from those who want very little information to those who want every detail the physician can offer. Thus, physicians should assess whether the patient desires, or will be able to comprehend, additional information.
Be Empathic
Empathy is a basic skill physicians should develop to help them recognize the indirectly expressed of their patients. Once recognized, these emotions need to be acknowledged and further explored during the patient-physician encounter.
Slow down
Physicians who provide information in a slow and deliberate fashion allow the time needed for patients to comprehend the new information. Other techniques physicians can use to allow time include pausing frequency and reinforcing silence with appropriate body language. A slow delivery of with appropriate pauses also gives the listener time to formulate questions, which the physician can then use to provide further bits or targeted information. Thus, a dialogue punctuated with pauses leads to deeper comprehension on both sides.
One study found that physicians typically wait only 23 seconds after a patient begins describing his chief complaint before interrupting and redirecting the discussion. Such premature redirection can lead to late-arising concerns and missed opportunities to gather important data.
As a side note, patient satisfaction is also greater when the length of the office visit matches his or her pre-visit expectation. In situations involving the delivery of bad news, the technique of simply stating the news and pausing can be particularly helpful in ensuring that the patient and patient''s family fully receive and understand the information. Allowing this time for silence, tears, and questions can be essential.
Keep it Simple
Physicians should avoid engaging in long monologues in front of the patient. Far better for the physician to keep to short statements and clear, simple explanations.
Tell the Truth
It is important to be truthful. In addition, it is important that physicians not minimize the impact of what they are saying. Saying that a patient has `gone'' or has `left us'', for an example, could be interpreted by an anxious family member as meaning that the patient has left his room to have a radiological film taken or to undergo a test. Alternatively, physicians who use "D" words (eg, dying, died, dead) when appropriate, effectively communicate and minimize confusion.
Be Hopeful
Although the need fth-telling remains primary, the therapeutic value of conveying hope in situations that may appear hopeless should not be underestimated. Particularly in the context of terminal illness and end-of-life care, hope should not be discouraged. For example, in situations such as the imminent death of a patient, hope can be conveyed to the family by assuring them that therapy can be effective in allaying pain and discomfort. Thus, even when physicians must convey a grim prognosis to a patient or must discuss the same with family members, being able to promise comfort and minimal suffering has real value.