Membership & Fellowship: Is Anybody Home? 5 Ways to Improve Provider-Patient Communication

By Stephanie Stephens

Sep 7, 2017

This article reprinted courtesy of HealtheCareers, provider of ACOG’s Career Connection online job board. Find your next job and career resources at ACOG’s Career Connection 

This is going to sound all too familiar. You, the clinician, explain a complex procedure to your patient, who looks at you with glazed eyes, trying hard to pretend they understand. You ask said patient, "Do you understand?" and he answers dutifully, "Um, yes." Then you ask, "Do you have any questions for me?" He's silent for a few seconds. Then he shakes his head and says, "No."

That's it. You're done. But really, you know you're not, because what you just said has probably gone in one ear and out the other. You confirm it when the patient calls the front desk the next morning and asks your receptionist to repeat everything again from start to finish. Problem is, she can't, and you have to do it over the phone at day's end.

Even after your stellar encore performance, you're still not certain your patient "gets it." What's a clinician to do? For Danielle Ofri, MD, PhD, and author of the book What Patients Say, What Doctors Hear, the best technique is to succinctly summarize the information. Suggest the patient take notes and then ask him to restate the key points.

"'Let me see if I’ve got this right” is a simple way to initiate a brief restatement of the facts," Dr. Ofri says. "Not only does this serve as a great way to get the facts straight, but it’s also a solid indicator to the patient that you are actually listening."

Five Concrete Ways to Improve Provider-Patient Communication

A 2010 review in The Ochsner Journal notes that effective doctor-patient communication can be a source of motivation, incentive, reassurance, and support for patients. That's all the more reason to improve it.

Most complaints about health care providers are related to issues of communication, not clinical competency. Doctors, nurse practitioners, physicians’ assistants, nurses, and other clinicians with better communication and interpersonal skills can detect problems earlier, prevent medical crises and expensive intervention, and provide better support to their patients. This may lead to higher-quality outcomes, better satisfaction, lower costs of care, greater patient understanding of health issues, and better adherence to the treatment process, the study says.

Anesthesiologist Michael Ho, MD, of Houston, tells physician blog Kevin MD that when it comes to communication of medical information, the way the message is delivered is often just as important as the information itself. Indeed, good communication really is the backbone of every patient-provider relationship.

Clinicians aren't really to blame for the fact that they don't necessarily excel at communication. "The earliest doctors were religious authorities, an authoritarian position that required little explanation to those being treated," he says. But patients aren't just a disease, they are unique people with unique personalities.

They don’t want to take orders, but to be proactive about what's being done. To do that, they need necessary information that you must provide in a way they can understand. To do this, Dr. Ho recommends that you:

1. Avoid medical jargon. Here's an example of what not to say: “We experienced an iatrogenic event that produced an untoward sequela, and while it is now quiescent, it may still recrudesce.”

Interventional radiologist Paul Dorio, MD, writes his own opinion for Kevin MD. "I was criticized for not using enough medical jargon when I spoke to the patients…I took that criticism as a compliment…Don’t talk science to your patients. It may show what you know, but it doesn’t give them any information."

2. Listen to your patients. Like, really listen, even if you're rushed. An older 1999 study from The JAMA Network likely still holds true; it found that "Physicians redirected the patient's opening statement after a mean of 23.1 seconds." Let them get what's on their mind off their mind.

3. Slow down. Try using a strategic pause to let statements sink in.

4. Assure understanding. Ask questions, repeat explanations, and encourage patient questions.

5. Be honest. This is a tough one. Yes, do it even when you want to protect patients from emotional suffering, or protect yourself from litigation.

This focus on great provider-patient communication isn't "all talk." It gets results, as consultant and speaker Karen Cook, RN, demonstrates in Hospitals & Health Networks. It "has a therapeutic effect for patients, even reducing pain, improving blood pressure readings, and increasing function," she says. "Patients who understand their doctors are also more likely to acknowledge health problems, understand treatment options, modify their behaviors, and comply with medication schedules."

That sounds like a win-win, and to ensure that you succeed, she suggests emphasizing nonverbal communication, too. "Studies show that a patient's perception of time spent increases if a [clinician] sits down. (This is why sitting at the patient's bedside instead of standing at the door is so effective.)"

You may be crazy busy, but at least try to appear unhurried and available. Provide emotional comfort and take time to answer questions. Remember that body language is also important, Cook says.

This provider-patient thing is and always will be very personal, says internal medicine physician Suneel Dhand, MD in his Kevin MD blog. "Answers for the patient do not — as lots of people sadly believe — rely on more computer time, funky expensive apps, or more complex bureaucracy."

Ironically, a new app to improve the provider-patient relationship around surgery is being pilot tested this fall. It's an invention of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Hospital, reports AHC Media.

The app guides patients with clear instructions pre-surgery, and informs them about what they should worry about post-surgery. It seems to nip the problem of conflicting information seriously in the bud. Their provider can also customize their checklists and track when a patient took a recommended action.

Foe or friend, technology is here to stay. But so are effective interpersonal relationships.

In a new whitepaper, patient relationship management firm SolutionReach says, "Communicating with patients in ways that best fit their needs, preferences, and lifestyles is critical to developing strong patient-provider relationships. Now, patients are looking to have more of a partnership with their provider. This shift in dynamic requires providers to adjust their approach to patient communication and engagement."

"The provider-patient conversation is the single most powerful diagnostic tool in the medical armamentarium," writes Dr. Ofri. "Enhancing the efficacy of this conversation and ensuring that each party is hearing as accurately as possible is one of the best prescriptions for good health."

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