Communication is one of the four core clinical skills, along with knowledge base, problem-solving ability and physical examination; a large body of evidence proves its importance. In one study, the duration of headache symptoms correlated more closely with patients’ perception that they were able to discuss their concerns with their doctor, than it did with the diagnosis, treatment, or referral to a specialist. In 70% of malpractice suits, communication issues are cited as a major factor. And more than 80% of doctors agree that the most significant factor in their personal satisfaction is the relationship with their patients. Given these impressive benefits, communication is a skill that we are wise to hone.
Our initial interaction sets the stage for the visit. By taking a moment to look at the patient’s name, brief history, and reason for the visit, we can enter a room calmly and welcome our patient with confidence. Seeing us smile and be in control helps patients trust us and begins to establish rapport.
In How Doctors Think, Groopman presents numerous cases in which the physician’s communication style interfered with good medical diagnosis and treatment. He criticizes medical education that trains us to immediately construct a mental differential diagnosis, after which we listen only selectively. In Skills for Communicating with Patients, Kurtz et al explain that we routinely interrupt patients 16- 18 seconds after they begin to speak, firing off a series of questions to hone in on our presumed diagnosis. Since patients rarely talk longer than two minutes, we would actually obtain much more relevant information by allowing them to tell us their history, uninterrupted.
It’s important to realize that the patient’s first complaint is not always his only, or even the most important, concern. So, after we listen attentively to our patient’s opening remarks, we should ask, “What other concerns do you have today?” By repeating this question, we can develop an agenda for the visit that will satisfy our patients and allow us both the comfort of knowing what we need to address and control over our time.
Much of our time is spent explaining things to our patients, yet it seems as if they recall very little of what we say. Since people remember 20% of what they hear and 70% of what they hear and see, we can improve their recollection by using visuals as often as possible – models, drawings, or handouts that we can personalize. In addition, using the “chunk and check” technique, we can ensure that patients understand what we are telling them. After each major point, pause and summarize or ask your patient to repeat what they understood from your explanation.
In closing the session, take advantage of the fact that after we use our patient’s name, we have his undivided attention for 30 seconds. This is the best time to tell the patient the most essential information. Ending with a hopeful wish for his improvement, as Beeson suggests in Practicing Excellence, helps to cement your partnership, an important skill in reducing malpractice claims. This suggestion may also create an expectation that will result in an improved outcome for your patient.
Many physicians feel that communication is something we do naturally, so there’s no reason to learn anything new. With better outcomes, fewer lawsuits, and the patient’s own happiness at stake, the few minutes spent learning these new skills might be the most important CME we receive all year.
Helane S. Fronek, MD, FACP, FACPh is Assistant Clinical Professor of Medicine at UC-San Diego School of Medicine and a Certified Physician Development Coach. Helane can be contacted at [email protected]