How can you be in a relationship with someone if you don’t speak the same language?

There is nothing more indelible than the words of an unhappy patient. In fact, in the past ten years, I can count on one hand the number of patients who have expressed dissatisfaction either in person, online, or on patient portals.  Even though negative patient interactions are so rare, unfortunately, I’m consumed by them.  I ask myself the same question that other physicians ask themselves every time something goes wrong: What could I have done differently?

It’s not an easy question to answer. In fact, we have all been trained to scrutinize every detail about our decision making so that bad things don’t happen to our patients. We do everything in our power to optimize patient outcomes and minimize complications.  But no matter how hard we try, some of our patients are still unhappy.

It gets worse.  We now live in a world where we are judged not only by our patients, by their families, by our peers, by hospital administrators, by the courts, but now we are being judged in a very public way: via online reviews.

Dirty laundry. Aired. On Mount Everest.

In order to be successful, not only do we have to take care of patients, but we have to achieve patient satisfaction. It is not difficult to get 5 stars one time. But maintain it over a career? Nearly impossible.  People say it can’t get any worse. Well, in medicine, we know that it can always get worse.  So imagine this situation where it can only get worse. Anything less than 5/5 stars makes us feel like we are sub-par.  Are we?

Well, it turns out many negative reviews are not about medicine, but about poor communication.  Yes, it is true that medical education now has more emphasis on how to communicate: Say these words; maintain eye contact; sit at the same level.  Are these things really all that we can do?

During medical school, my family had a lot more time than I did to read about non-medical subjects. Whatever natural disaster was going on, whatever political turmoil, the latest social media challenge, the latest books that were published, I got a briefing every time I spoke with my parents or my sister.  They were essentially my very own Blinkist.

I remember when my sister was trying to describe this book called The Five Love Languages: How to Express Heartfelt Commitment to Your Mate written by Gary Chapman.  The five languages include, 1) physical touch, 2) acts of service, 3) gifts, 4) words of affirmation; and, 5) quality time.  In this model, each person has a primary and/or secondary language to express and receive love.  It makes a lot of sense.  We can all think of a couple where person A and person B got their communication wires all crossed, and they ended up arguing or separating.

Chapman commented in an interview that even if the two parties have naturally different languages, as long as both are willing to meet the other, a connection is possible. The worst scenarios are: 1) If one completely ignores the other’s needs, or 2) if one’s preferred language is the other’s lowest priority.

Well, several years ago, I had a revelation.  I had been preparing to perform surgery, but the patient never showed up.  I found out later that the patient had canceled because I had not given tangible patient instructions.  I was perplexed. Why would anyone care so much about a few pieces of paper that they were willing to forego treatment?  I then remembered the five languages.  I was so focused on an act of service, I didn’t even think to give a gift.  I realized that just because I don’t communicate with gifts, doesn’t mean my patients don’t.  Just because I don’t speak French, doesn’t mean my patients don’t. I have to find a way to communicate in French.

There are many examples of poor communicate.  “The doctor didn’t spend enough time talking to me” (time), “My doctor didn’t explain things to me very well” (words), or “My doctor didn’t even examine my knee when I said it hurts” (touch). With shorter visit times and the adoption of telemedicine, our communication needs to be optimized.

Maybe we can learn from relationship experts. After all, the patient-physician relationship is, first and foremost, a relationship. Ideally, if we can identify patients’ preferred mode of communication, or routinely use a variety of languages, we can maximize our chances of getting it right.  We should use all 5 languages.

Physical touch. You don’t have to hug everyone (especially now with COVID-19), but take time to examine the body part that the patient is concerned about. Make a point to wash hands and sanitize the workspace and equipment.

Acts of service. Help with a wheelchair, hold a door, or escort the patient to the room yourself.

Gifts. This doesn’t have to be extravagant.  Provide education pamphlets or bottled water in the office.

Words of affirmation. Show empathy and encourage your patients.  Thank those who are accompanying the patient.

Quality time. Allow adequate time for patients to talk without interrupting. Thank patients for waiting if you are running late.  Maximize the amount of time with patients by spending less time on the computer.  (Utilize scribes, transcription, or dictation services.)

This is by no means fool-proof.  I just think that perhaps we need to reach out to people outside of medicine for answers. I often say to people that I went into medicine because I’m not as smart as the PhDs, economists, lawyers, engineers, historians, environmentalists, etc.  The list is endless. I’m just eager to learn from them.  As for my original question: What could I have done differently?  Well, suffice it to say that no one leaves my office without patient instructions.

The author would like to acknowledge Jonathan Lee, Jacob Tower, and Lam Ho.

Yan Ho Lee is a plastic surgeon.

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