“We experienced an iatrogenic event that produced an untoward sequela, and while it is now quiescent, it may still recrudesce.”
No one likes to be given bad news, especially of disease. But first, you have to understand what it means. 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 is the backbone of every patient-provider relationship.
The roots of poor health care provider communication run deep, stemming from the origins of medicine itself. The earliest doctors were religious authorities, an authoritarian position that required little explanation to those being treated.
As medical science replaced mysticism, physicians aligned themselves with the elite of society, again placing themselves above their patients. Even when taking their Hippocratic oaths, doctors were only pledging to first do no harm, not explain their methods. Patients were expected to trust their physicians’ good intentions and silently accept their prescriptions for treatment.
What patients expect today
Today, everything has changed. Patients are no longer regarded as mere symptoms or diseases; they are unique personalities. Shared decision-making has replaced autocratic paternalism. The patient must be made aware of treatment options and give their consent before treatment can begin. It’s ethical, and it’s the law.
Most would agree that the greatest equalizer in this paradigm shift to patient-centered care has been the internet. Patients now have access to the same information as physicians — and they let their physicians know it. Who hasn’t been told by their patient, “I think this is what I have, and this is how I think it should be treated”? And that was the first visit.
Doctors, be warned. Patients don’t just want to be told what to do; they want an active role in deciding what’s being done. And we are expected to provide the necessary information.
The importance of good communication
A patient’s ability to make the right choices depends on the availability of accurate information. Physicians have an obligation to not only supply that information, but to do so it a way that is clear and understandable. Here are six time-honored techniques that may be of help.
1. Avoid medical jargon. After almost a decade of medical training, it’s natural for young physicians to let medical jargon roll off the tongue. But when talking to patients, medical terminology can seem like a foreign language. 15% of patients age 25 years and older do not have a high school diploma. And what about those for whom English is not their primary language? To them, even terms like hypertension can sound like white noise. Be sure you avoid complex terms, break concepts down into smaller pieces of information, and keep it simple.
2. Listen to your patients. Doctors may do well to listen as much as they talk. A frequently cited study showed physicians redirected the patients opening statements after a mean of 23 seconds. Don’t be that physician. Patients have their own agenda, and listening to them may reveal deeper concerns, new problems, useful diagnostic information, and potential barriers to therapy.
3. Slow down. Physicians have a reputation for rushing into a room, asking a few superficial questions, performing a perfunctory exam, and hurrying out. To save time, they may provide an “information dump”, unloading all the information as quickly as possible. Such pressured practices do not foster good communication. Try slowing down. A simple tactic is to allow a pause, creating a strategic silence. This gives time for the patient to think and information to sink in. It can be especially important when delivering bad news. The mind needs time to reset and recover.
4. Assure understanding. It has been said that most of the information presented to patients is immediately forgotten, and nearly half of what is retained is incorrect. Doctors need to do a better job making sure patients understand — and remember — what is being said. Thus, you may wish to offer the most important information first, and bring up smaller issues later. Also, try to ask questions to assess patient understanding, repeat explanations as needed, and encourage patient questions. Offer a plan for follow-up. Consider using printed information and instructions.
5. Be honest. There are two reasons why doctors sometimes fail to completely disclose the truth: to protect patients from emotional suffering, or protect themselves from litigation. Neither is justifiable. We may be well intended in attempting to shield patients from grief, but not at the expense of omitting essential information. Similarly, full disclosure, including admission of any medical error, is an evolving standard. Instead of increasing the chances of a lawsuit, full disclosure, including an apology, may actually decrease the chances and costs of litigation. Honesty is the best policy.
6. Be empathic. In the race to pass exams, see patients, stay abreast of guidelines, and get some sleep, doctors often forget why they went into medicine — to help patients feel better. As part of that goal, a patient’s emotional health should not be overlooked. The tone with which you speak can lessen pain and reduce anxiety. Subtleties in demeanor — facial expression, body language, time spent, acknowledgment of patient feelings — convey concern and positive regard. In addition, noting a patient’s emotional state may suggest depression or suicidal ideation. Genuine caring has a long-term impact that reaches far beyond the moment. Remember the adage: treat others how you would like to be treated.
Benefits of good communication
A recent meta-analysis suggests that offering both emotional and cognitive care, the two elements of communication, may produce a small but significant effect of patient outcomes. Just as importantly, sound communication has become the cornerstone of patient-centered care. It helps obtain an accurate history and physical, achieve patient adherence to therapy, and improve patient satisfaction: the Holy Grail of patient-centeredness.
Perhaps most importantly, by communicating effectively, we build trust and cooperation between provider and patient, equal partners in the delivery of modern health care.
Michael Ho is an anesthesiologist and owner and founder, Anesthesiology Consultants.
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