Enhancing doctor communication

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As doctors, we have the responsibility to educate our patients. Unfortunately, we have no didactic training regarding communication with our patients. This blog will focus on suggestions for improving communication and rapport with our patients.

Two scenarios of ineffective communication:

1. A defensive doctor

Patients ask for additional information or credible websites to learn more about their medical problems. The doctor responds, "If you don't trust me, you should go elsewhere."

2. An inattentive doctor

The doctor operates on a patient and leaves the surgical area without speaking with the patient's family. The family asked the secretary in the surgical reception area to talk to the doctor and heard that the doctor was in his office and couldn't take a call from the family.

These two doctors have lost rapport with their patients\families. Both scenarios are examples of dismal communication skills. These examples may lead to losing confidence and trust in the physician, which may impact outcomes and place the doctor at increased risk of litigation.

Studies have shown that doctors overestimate their ability to communicate with their patients. Studies on doctor-patient communication have demonstrated patient discontent even when many doctors consider the communication adequate or excellent.1

Nearly 75% of the orthopedic surgeons surveyed believed they communicated satisfactorily with their patients. However, only 21% of the patients reported satisfactory communication with their doctors. Patient surveys have consistently shown that patients want better communication with their doctors.2

A doctor's communication and interpersonal skills include history taking, making an accurate diagnosis, recommending appropriate treatment, and establishing a caring relationship with patients. These are the core clinical skills in medicine to achieve the best outcome and patient satisfaction.

Patient-centered medicine has not always been standard practice. For example, in the 1950s to 1970s, most doctors considered it inhumane and detrimental to terminal patients to disclose bad news because of cancer's bleak treatment prospects.3 Today, the health consumer movement has led to the shared decision model putting the patient at the center of doctor-patient communication.

Benefits of enhanced communication

Not too long ago, physicians were judged by their "bedside manner." Good doctor-patient communication can help enhance patients' emotions, facilitate understanding of medical information, and better identify patients' needs, perceptions, and expectations. Patients reporting good communication with their doctor are more likely to be satisfied with their care, especially to share pertinent information for accurate diagnosis of their problems and comply with the doctor's advice.4 When patients understand the nature of the treatment and the need for follow-up, this is strongly associated with their recovery. Others have observed a decrease in the length of hospital stay and, therefore, the cost of individual medical visits and fewer referrals.5

A patient-centered encounter makes a better patient likely to have a favorable outcome and doctor satisfaction. Satisfied patients are less likely to lodge complaints or initiate malpractice suits.

Satisfied patients benefit doctors with greater job satisfaction, enhanced online reputation on medical review sites, less work-related stress, and reduced risk of burnout.

Suggestions to enhance patient communication

Breaking the ice. Please don't start the dialog with a new patient by launching into their medical problem. Instead, ask an open-ended question about what they do, where they live, have traveled, their hobbies, or their families. This allows you to focus on the whole patient rather than an organ system.

Communicate by listening. When physicians monitored patients, the average time before the physicians interrupted the patient was sixteen seconds. This abbreviated time hardly qualifies as good listening.

When patients share their symptoms, they must demonstrate curiosity and concern. Ask clarifying questions. Ask how the symptom or problem is impacting lives. Avoid questions that are answered with yes or no.

Focused or active listening means looking eyeball-to-eyeball with the patient and not the computer. If you multitask and use your cell phone, you can't convince a patient you are listening. Also, inform your staff that you are only to be interrupted if there is an emergency, such as a call from the emergency room, the operating room, or the intensive care unit.

Check your "doctor speak" at the door. This an excellent study with eye-opening results on common phrases we use as healthcare providers and how often patients do not understand them. Only 9% of patients understood what was meant when asked if they had been febrile. Only 2% understood what was meant by "I am concerned the patient has an occult infection." Only 21% understood that "your x-ray findings were quite impressive" was bad news.

Other terms physicians use to explain things most patients need help understanding include bilateral, systemic, and evidenced based. As you explain things to patients, check back to review that they comprehend your explanation.

Patients appreciate honesty and sincerity. Many symptoms in medicine end up without a diagnosis. When the diagnosis is uncertain, it is important to be honest with the patient and share why you think it is okay to initiate definitive treatment once more information is available. This also benefits patients' trust when unsure about the diagnosis because it indicates that you don't have an answer for everything.

Another effective way to connect with your patients is to ask what they think is causing their symptoms. The answer to this question may give insight into patients' fears. You can discuss their worries, even if it isn't something you are considering. Knowing what they are fearful of, you can reassure them when appropriate.

Finally, communication includes answering the patient's questions before concluding the encounter. Answering questions can be facilitated by giving patients a 3 x 5 card to write down what questions they would like answered on their visit. (Sample from my practice is shown below) This avoids the uncomfortable situation where your hand is on the doorknob, and the patient has just one more question.

Courtesy of Neil Baum, MD

Bottom Line: Patients' most common complaint about their healthcare is waiting for an appointment and then staying in the reception area to see the doctor. The next most common complaint is doctors' failure to communicate effectively with their patients. Most complaints about doctors are related to communication issues rather than clinical competency. Of course, patients want doctors to diagnose and treat their illnesses, but they also appreciate good communicators. Since words are the primary means to communicate with our patients, let's try to get those words right.

References

1. Stewart M. A. Effective physician-patientcommunication and health outcomes: a review. CMAJ. 1995;152((9)):1423–1433
2. TongueJ. R., Epps H. R., Forese L. L. Communication skills for patient-centered care:research-based, easily learned techniques for medical interviews that benefitorthopedic surgeons and their patients. J Bone Joint Surg Am. 2005;87:652–658
3. Baile W. F., Buckman R., Lenzi R., Glober G., Beale E. A., Kudelka A. P. SPIKES—a six-step protocol for delivering bad news: application to the patient with cancer. Oncologist. 2000;5((4)):302–311
4. Aremu, T. O., Oluwole, O. E., Adeyinka, K. O., & Schommer, J. C. (2022). Medication Adherence and Compliance: Recipe for Improving Patient Outcomes. Pharmacy, 10(5), 106.
5. Little P., Everitt H., Williamson I., et al. Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations. BMJ. 2001;323((7318)):908–911