Physiatry Practice Management Resources

Communication Matters It's not rocket science, yet it is a concept routinely ignored in the education of clinicians. Patients know that communication matters, and it is often poor communication in the face of a bad outcome that initiates legal action by the patient turned plaintiff.

Ineffective communication often reduces the accuracy of a clinician's diagnosis. Indeed, research shows that clinicians allow the patient only 18 seconds to present the story of their illness before interrupting. Additionally, the same research shows that only two percent of those patients ever get the opportunity to complete their story. By cutting off the flow of information from the patient, the clinician is often deprived of facts that are likely germane to a correct diagnosis. Numerous studies also indicate that communication between clinician and patient is the single most effective predictor of patient adherence to a treatment plan. If the clinician utilizes effective communication skills, the patient will become an educated participant in the treatment, thereby increasing the likelihood of compliance. Add to this mix the increased pressure from the insurance industry to shorten patient visits, and good communication skills become an essential element of the clinician-patient relationship.

The concept of effective clinician-patient communication is a necessity, not an option. Because communication is both a science and an art that can be learned and mastered, there are many resulting benefits for those who work diligently to improve their technique, not the least of which is increased clinician satisfaction.

According to the Bayer Institute for Health Care Communication, a clinician's role in communicating effectively with patients can be broken down into a process that includes the following communication tasks: engagement, empathy, education and enlistment.

Techniques for successful engagement include showing interest in the patient as a person, eliciting the patient's agenda and expectations up front(perhaps at the expense of your own agenda), negotiating and prioritizing the agenda for the visit, and using the patient's language rather than medical jargon.

Remember the expression, "You don't get a second chance to make a first impression." Be cognizant that both your actions and your words express your interest in the patient as well as the medical problems they bring to the table.

The outcomes of successful engagement are rewarding. For example, the quantity and quality of the diagnostic information available will improve. The groundwork for a successful relationship will have been laid. Additionally, the patient will have a sense of partnership with the clinician, which will facilitate adherence to a treatment regimen.

Empathy

Empathy is sincere—and successful—when a patient acknowledges that he or she has been seen, heard, and accepted as a person. This seems like a simple concept, yet the effective use of empathy presents common dilemmas for clinicians. Once again, clinicians tend to fall back on "comfortable" medical language that creates a barrier to empathy. Additionally, clinicians often confuse sympathy with empathy. What's more, although research proves it to be untrue, some clinicians may feel that empathizing with a patient will require more time than they have to give.

Techniques that allow the clinician to exhibit empathy are varied. Initially, new patients should be seen fully clothed and proper introductions made. Creative clinicians find ways to accomplish this without adding time to the visit. For example, introductions could be made to the fully clothed patient in the waiting room. Once inside an examination room, patients should be seen on roughly the same line of sight. Be mindful of physical barriers. Desks, charts, and poor eye contact have been proven to impede empathy.

To effectively hear a patient, invite him or her to share thoughts and feelings and then affirm them by using the patient's own words. Hearing also means allowing the patient to correct your understanding of what was said to ensure agreement.

Acceptance requires acknowledging the patient's thoughts and feeling while reserving judgment. It also allows for self-disclosure, when appropriate. Don't tell your life story, but do share anecdotes that will facilitate the clinician-patient bond. Keep in mind that by encouraging "windows of opportunity" through the use of open-ended questions, you'll be better prepared to address the psychological and social, as well as medical, needs of the patient.