Doctor and patient communication has been ubiquitous in the American zeitgeist over many decades in the form of the empathetic bedside manner of television doctors. The likes of Marcus Welby (Marcus Welby, M.D.), J.D. Dorian (Scrubs) and Meredith Grey (Grey’s Anatomy) have modeled our ideal in their demonstration of care and communication with patients.
But what happens in the real world? A portion of doctor/patient communication comes from the personality of the physician or other healthcare provider. The larger part comes from the content of material that must be communicated and the trained skills of the communicator.
What Kinds of Communications Happen Between Doctor and Patient or Caregiver?
Let’s look at communications from a patient perspective. How does the patient interpret the communications he or she hears?
- Interrogation – Why all these questions? Doesn’t the doctor believe the patient? The patient came in with a specific ailment, yet the doctor is interested in all kinds of unrelated issues. (Spoiler alert for patients: Many conditions are interrelated and can even tie back to upbringing, relatives, and social behavior, so this “extra” information can be invaluable for diagnosis.)
- Good news – The diagnosis and prognosis are upbeat. It’s hard for a doctor to deliver good news poorly, especially if the patient has been waiting fearfully and is overwhelmed with relief.
- Bad news – This time, diagnosis and prognosis are poor. The patient may go through stages of grief (including disbelief, anger, sadness) before reaching acceptance. Hopefully the doctor won’t do “dump and run” communication, but will help the patient and family caregivers drive toward acceptance.
- Chit chat – Small talk can be useful, especially if it helps the patient get more comfortable with the doctor and better able to share information. On the other hand, patients may be worried about medical costs and think the doctor is wasting time and driving up the bill.
- “Just the facts” – If the doctor seems to have no time for listening to the patient and doesn’t appear to care, the patient may follow this lead and clam up, not revealing critical information for diagnosis.
- Information and instructions – What does the patient learn that he or she couldn’t find on WebMD or other online resources? Beyond any medical procedures themselves, instructions from the doctor after a thorough review and diagnosis might be the most valuable part of patient care, as this helps the patient appropriately follow the recommended care after leaving the hospital.
- Reminders – To some patients, reminders might seem to be just nagging. They know they need to lose weight, stop smoking, exercise more…and when the doctor reminds them at every visit, it starts to feel hurtful. Doctors must break through this resistance.
The good news for health care providers is that they don’t have to be born with excellent bedside manner or follow a script as the imaginary TV doctors do, but can actually build very solid communication skills incorporating both technical content and interpersonal feelings.
Models of Healthcare Communications
One goal of communications in general is to share or receive information correctly and compassionately, demonstrating respect for the other party. Healthcare is no different. However, communications effectiveness doesn’t just happen. Standardization and training help all communicators improve their skills. General communications advice can be applied to the healthcare situation:
- Listen…and don’t interrupt – Patients may be intimidated by the doctor, uncertain about what might be useful information, or simply struggling to put their feelings into words. When needed, use open-ended questions to draw out more information. If the doctor totally takes over the conversation, including assuming input, vital information may be missed.
- Use welcoming body language – Remember Albert Mehrabian’s work showing that body language and tone of voice are very important to being liked, which has often been applied to communications effectiveness. Open stance, warm facial expression, eye contact, nodding, and comforting tone all set the stage for effective communications, sometimes more importantly than words themselves. These positive actions are things you can learn from good TV doctors even if their medical information is occasionally inaccurate.
- Share facts – Clear up misinformation patients may have gotten from friends and the internet. Provide education from evidence-based science.
- Share feelings – Show empathy (not sympathy). Help the patient leverage feelings of concern toward positive action.
- Use positive communications – Relate back what you have heard to be certain you have understood. For example, “So you have headaches and vertigo, but no vomiting and this happens only in the morning. Is that right?” This not only solidifies your understanding of the situation, but may prompt the patient to clarify or add more information.
- Bring closure to the conversation – At some point, after answering outstanding questions, the doctor is obligated to bring closure to the discussion. This may include patient directions, prescription, referral, and well wishes.
Note that these general communications tips apply not just to doctors, but to anyone in the healthcare facility, from the volunteer telling arrivals how to get to their destination to the contract employee delivering meals to the transport worker who may be the last person the patient interacts with in the hospital to the admin receiving patient complaints.
Several healthcare-specific models can be helpful.
REDE – The REDE model of healthcare communication is relationship-centric. In fact, the acronym stands for Relationship: Establishment, Development and Engagement. Doctors can learn, practice, and critique their success in effective communications using the REDE checklist, which offers very specific advice for communications at each stage of the relationship model.
RESPECT – While the concept of respect is important itself, RESPECT is also an acronym for Respect, Explanatory model, Social context, Power, Empathy, Concerns, Trust. Again, a useful checklist provides not only definitions of each RESPECT phase, but also sample questions and statements that model how the doctor can apply this advice. The RESPECT approach is particularly effective in communicating across race and other perceived barriers to doctor/patient social equality, which tend to inhibit effective communications.
What about Communications with Family and Caregivers?
The same guidance for effective and respectful communications with patients applies to communications with their caregivers. In many cases, when patients are recovering from surgery, in pain, or otherwise not fully cognizant, the patient’s family members will by necessity be the primary points of contact. However, it’s important to remember that communicating with the patient is the doctor’s responsibility. Be certain that any information given to the patient is accurate, honest, and consistent.
Two parts of caregiver communication are especially important.
- Diagnosis/prognosis is the good news/bad news part of the doctor’s messaging. Given the intense emotions that may be present on both sides of the communication related to serious medical issues, using a “standard work” approach to this communication can be very helpful. While not functioning as an automaton, the doctor can communicate in a structured way such as the S.P.I.K.E.S. strategy proven to help the patient understand and deal with bad news.
- Follow-up care instructions have a big impact on the ultimate success of patient care. Here the doctor needs to provide written and oral communications on what to do and why, both to the patient and to any caregivers who will be responsible for the environment in which the patient recovers. Advice about taking medications appropriately, abstaining from alcohol, eating or avoiding certain foods, getting exercise or avoiding activities, and ensuring checkups are not just niceties, but critical elements of care leading to long-term recovery.
Doctor/patient communication is critical to quality of care, patient experience and satisfaction, and even preventing malpractice suits. When doctor/patient communication goes poorly, it’s like the “evil doctor” on the TV shows, the one seen to be brusque, make mistakes, ignore the patient, and intimidate patients so much that they hide information, to their own detriment. On the other hand, when communication goes well, the situation becomes that of the satisfied, relieved, recovering or recovered patient, who heartily says, “Thank you, Doctor!”
Get started in this very important area or learn how to make improvements in your existing cross-facility communications strategy with some help from EON. Contact us to get started.