By Debra Wood, RN, contributor Mar 07, 2018
Good outcomes require good doctor–patient communication that builds patient trust in the physician or other provider of care. Internists and other practitioners should aim to develop a relationship with their adult patients, when possible. But that kind of time isn’t always available.
“The doctor–patient conversation is the single-most important and powerful tool in medicine,” said Danielle Ofri, MD, PhD, D Litt(Hon), FACP, associate professor of medicine at the New York University School of Medicine and author of What Patients Say, What Doctors Hear.
“The patient story is the primary data we use to make a diagnosis and treat.”
Ofri said she believes physicians and nurses want to be with patients and talk with them, but often the clinicians feel overwhelmed with hectic schedules and documentation requirements. Reminding oneself to listen can produce more effective communication in healthcare.
Patient satisfaction goes up when physicians truly listen. When they don’t, more errors can occur. Oft reported that malpractice data shows communication problems are responsible for more than half of cases.
“If you want to make the right diagnosis, you have to put [communication] front and center,” Ofri said.
Robert M. Arnold, MD, professor of medicine and director of the Institute for Doctor-Patient Communication at the University of Pittsburgh Medical Center in Pennsylvania, indicated that early in a physician’s career, it might seem like magic how an attending gets valuable information from a patient.
“It’s not so much magic,” Arnold said. “They are trained and have skills that clinicians can learn to do.”
Ronald Epstein MD, author of Attending: Medicine, Mindfulness, and Humanity and a professor at the University of Rochester (NY) School of Medicine and Dentistry, added, “When I teach communication skills to doctors, I don’t just focus on what to say. I help them to be more mindful, to be aware, attentive, curious, open, and present. In that way, they understand their patients and their patients feel known and understood.”
Building patient trust has become more challenging as organizations employ clinicians without a partnership track, according to Tom Davis, MD, FAAFP, a consultant based in St. Louis.
“In these models, the organizations wish the patient to identify [with] the organization itself as their medical home rather than individual clinicians—making it very difficult for clinicians to build trusting relationships,” Davis said.
However, it still is possible to have effective communication in healthcare and build patient trust.
“There are many small things that can be done that will go a long way to build trust for optimal communication between a doctor and their patients,” says Anita Lesko, BSN, RN, MS, CRNA, in Pensacola, Florida, author of The Complete Guide to Autism & Healthcare: Advice for Medical Professionals and People on the Spectrum. “Patients do shop for a doctor they feel comfortable with and trust. Simple steps can make it happen.”
RELATED: Which Physicians Spend the Most Time with Patients?
Address the little things
Physicians should aim to create a positive experience for the patient. If the patient has waited three hours in a noisy waiting room, he or she will likely be less receptive to productive doctor-patient communication.
“From the moment a patient steps into the waiting room, if there's bright lights, TVs playing, crowded, and unpleasant smells, they are already set up for a negative experience with the doctor,” Lesko said. “If, however, the patient enters the waiting area and it’s lit with subdued lighting, comfortable chairs well-spaced so no crowding, no TVs, possibly some plants or a small waterfall, it will create calmness in all present.”
Start the visit off right
Davis suggested employing what he called “visit hygiene,” which involves some simple but effective best practices:
● Knock on the door, then pause before opening
● Look the patient in the eye
● Call him or her by the proper name
● Shake hands
● Introduce yourself if you don’t know the person
● Sit down at a lower level than the patient
● Engage briefly in personal, nonmedical banter
● Do not look at the computer initially
Ofri recommends taking the first minute with the patient and listening to him or her without interrupting, without looking at the computer—something she calls “full frontal listening.”
“Most patients in a minute will tell you what the important things are,” Ofri explained. “You are making an investment with the patient. They are much more likely to tell you want is going on if you give them the opportunity.”
Arnold suggested setting an agenda and goals for the visit with the patient. This can start with a simple statement like, “Let’s make sure we know what we want to accomplish on the visit today.” Taking notes and double-checking that everything was covered at the end of the visit is just as important.
Ask questions and actively listen
Many patients have no one to listen to their story. Even if the physician cannot solve all their problems, truly listening to what patients say can prove beneficial.
“The act of listening can be healing,” Ofri said. “We are in a privileged position to listen and must not forget how valuable that is for the patient.”
Patients often express emotions and want physicians to tend to those emotions.
“Being available for your patient, working closely with them on their care needs, getting them through a hard patch—these are things that really bond clinician and patient,” said Thomas. He also recommends that physicians end each visit with a positive word.
Arnold suggested physicians end the visit by asking the patient to “teach back” instructions, next steps and information about what they learned from the visit. This helps ensure the patient listened, as well, and knows his or her role in the care plan.
“It will improve people’s satisfaction, because it shows their doctors are really listening to them and attend to what their issues are,” said Arnold.
Effective communication in healthcare can be learned and improved. If a physician’s communication skills could use improvement, Arnold suggested that they take a course and practice them.
Greater awareness and good communication habits can help, too.
“Being aware communication is important and you want to put the effort there is enough for the average doctors to be more mindful in their practice,” Ofri said.
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