Communication Tips for Physicians

When pediatrician Elizabeth Rider walked into her exam room to see a toddler a few years ago, she was puzzled. The child's mother was concerned about a rash the child had developed, but two practitioners had already examined the patient at two previous appointments, and both had reassured the mother there was nothing to be concerned about.

"There was some frustration among staff," acknowledges Rider. "I thought, 'Well, there's a reason she's back.'"

Shortly after the appointment began, Rider, who is now an assistant professor of pediatrics at Harvard Medical School, asked the child's mother if she was concerned about anything else. The woman replied, "My husband died."

At that moment, both Rider and the mom realized the mother's concern wasn't the rash, it was the bigger picture. "When you have a loss, when somebody dies, patients worry about other losses - and nobody heard her," says Rider, who spent the rest of the appointment talking with woman about her situation and providing coping resources. As a result, the woman's anxiety about the rash dissipated, and the real issue underlying her anxiety was addressed.

"By building rapport, understanding the patient's perspective, and seeing the patient as a person in every encounter, we won't miss the big things," she says. "It doesn't take much time to say, 'Any other concerns? What else is going on?'"

Simple communication missteps like the one Rider solved have big consequences for doctors and patients. They often lead to wasted time, poor outcomes, decreased patient satisfaction, and malpractice lawsuits. Here's how to brush up on your communication skills to ensure your patients are getting exactly what they need from you.

At the core

You're dealing with complicated diagnoses, critical decisions, shorter patient visits, and declining reimbursements. It's easy to let communication slide to the back burner. Don't let it. "Communication isn't something that you have to do on top of being a physician," says Jason Wolf, executive director of The Beryl Institute, an organization dedicated to improving the patient experience. "It's really a core clinical skill and a muscle that you have to develop through constant practice."

That's because communication rests at the "core" of patient care, says Wolf. Communicating well ensures your patients understand their current situation and your directions for ongoing care, he says. It also ensures you understand your patients' perspectives so that you can tailor their treatment plans to best suit their needs and values, says Houston, Texas-based regional hospice medical director and palliative-care physician Marcia Levetown, who teaches communication skills to physicians.

Evoke what you know

We could provide you with a list of communication skills - such as making eye contact, sitting near the patient, and listening closely - but you've seen them all before. The trick is developing those skills and making them your own. "The 'aha' is this isn't rocket science," says Wolf. "Effective communication is just about intentionality and bringing our humanness in the delivery of healthcare."

Remember that as long as you put the patient first, there is no one right tactic to use when communicating, says Levetown. "You can't put on a costume or a mask," she says. "You should develop your own style that you're comfortable with."

The good news is that finding your own style isn't a "big arduous process," says Wolf. It's simply cultivating what feels natural to you. "Is it adjusting the tone of voice, the posture, the gestures? Is it having a question that you want to ask that sort of sets the tone for you? Is it being a little bit self-revealing or self-effacing to kind of remove the mystique of being a physician, which to so many people is intimidating and sometimes scary?" he asks. "You have to practice style and communication etiquette that matches who you are."

Tailor your skills

While honing your skills, practice with and learn from your fellow physicians and staff members, says Wolf. For instance, invite a physician colleague to shadow you and offer feedback, and vice versa. Or, role play different patient encounters. "The same way physicians learn through scenarios in medical school around how they're going to diagnose ... this is around the human side of healthcare, so I think it requires the same kind of practice," says Wolf.

As you practice your approach, get feedback from a variety of individuals such as colleagues, communication experts, and especially, patients, says Levetown. "You need to really do a 360."

Though you should communicate in a way that suits you, you also should cater your approach to each patient. "You have to understand who they are and what they're looking for," says Levetown. For instance, some want less detail from you, some want more; some want you to make the big decisions, others want to take a more active role, etc. In addition, you need to determine the treatment plan that will work best for that individual patient.

The best way to do this is by really listening to your patients. Try to mentally shut out all the outside noise - the overhead pages, the cell phones, thoughts about your next appointment, etc., says Rider, who is also director of academic programs at the Institute for Professionalism and Ethical Practice at the Boston Children's Hospital, Harvard Medical School. "Try to clear your mind and just be there, be present, really listening at that moment in time, and then you can hear. You can hear what the patient is saying," she says.

Time-saving techniques

Time constraints due to fee-for-service reimbursement make it harder to communicate thoroughly, but that's all the more reason to ensure you are communicating well from the get-go, says Rider. "It's really important to have really well-formed communication skills, to be able to set patients at ease quickly, to be able to elicit their concern, to be able to use empathy, to be patient-centered," she says. Plus, communicating well will actually save you time in the long run. Here are some tips to make your communication more effective:

Address emotions. Pause to acknowledge any feelings expressed by the patient. "When the patients throw out that emotional lifeline to you and you ignore it, they'll come back to it [later], so in fact that interview time is lengthened because they keep making the attempts, but you ignore it," says Levetown.

Ask open-ended questions. That way patients are more forthcoming about their main concerns from the start, says Levetown. As a result, you will better focus the appointment and you will be able to avoid the "oh, by the way..." from the patient as the appointment is winding down.

Translate. Explain things in an unhurried, clear manner, says Wolf. "If [physicians] lose us in scientific language or medical explanation that actually creates more fear, anxiety, or confusion, they may actually create a disconnect and cause more work for themselves."

Six critical communication skills

• Remember the power of first impression. Patients often decide how they feel about their doctors during the first three seconds of the encounter, says Jason Wolf, executive director at The Beryl Institute. "Exude care immediately, even if it's just simply looking happy to be in that room or being warm and welcoming."

• Be open. Don't cross your arms and legs or turn away from the patient, says palliative-care physician Marcia Levetown.

• Acknowledge biases. Some patients will push your buttons. Pause and reflect before meeting with these patients, says pediatrician Elizabeth Rider. "Being self-aware gives people more room to say, 'Well, it really isn't about me, the doctor, it's about the patient.'"

• Be silent. Stay quiet much more than you think is necessary, says Levetown. Patients will be more informative, and you will listen more closely.

• Reflect. Reiterate your patients' responses to your questions in your next sentence. That way they know you've heard them, says Levetown.

• Make contact. Sit close to the patient, make eye contact, and practice "appropriate touch," says Wolf. "That creates a connection and understanding."

Communicating well in the age of EHRs

EHRs make it more difficult to ensure you're communicating well with patients. For tips, read "Physician-Patient Communication Tips when Using EHRs."

Four tough communication strategies

Communicating bad news and dealing with noncompliance are two difficult patient encounters. Strategically communicating can help. For tips, read "How Physicians Can Communicate to Increase Patient Adherence," and "Communicating Bad News to Patients."

Aubrey Westgate is an associate editor at Physicians Practice. She can be reached at aubrey.westgate@ubm.com.

This article originally appeared in the January 2013 issue of Physicians Practice.