Blog | Monday, October 16, 2017

Golden communication tips for doctors

It's something that's not taught anywhere near enough as it should be in medical school, but every practicing physician quickly realizes that communication is everything in health care. It's the foundation of the doctor-patient relationship, and what patients will judge you on. Sure, doctors are among the busiest professionals out there. We do an incredibly hectic job. But it's so imperative to remember the importance of that interaction with your patient, and to treasure those few minutes you have with them. It's essential not just for patient experience, but also your success as a physician. Here are some things you should always do, Doctor.

1. Knock
Before entering the room, always knock on the door as you walk in. Of course you are going to enter anyway, but knocking just displays a sense of politeness and consideration.

2. Greeting
Walk in calmly, confidently, and in a professional but friendly manner. Ideally shake hands. A nice firm handshake, but not as firm as you would in certain other situations such as a job interview. Often, the patient will extend their hand anyway when they see you walk in. Smile. Of course, a smile doesn't come naturally to everyone! But as far as social science is concerned, it generally displays a sense of openness and friendliness. Obviously, it may not be appropriate to smile if it's a bad clinical situation, but a measured smile may still be appropriate when you first meet. Using the patient's first or a more formal “Mr.” or “Mrs.” is a judgment call. Older people may prefer the more formal greeting.

3. Sit down
Always sit down with the patient. Research shows that when doctors sit down, patients perceive them to be in the room significantly longer than doctors who stand up (even though they were found to actually spend less time in the room than the doctors who stood up!). Patients have also been shown to be more satisfied with their care and expressed better understanding of their condition when their doctor sits down. Moreover, it's more comfortable for the physician as well, instead of towering over the patient and peering down.

4. Let the patient speak
Studies show that physicians interrupt their patients after an average of just over 20 seconds of speaking. Yes, that's right—20 seconds. Again, nobody doubts how busy you are and the need to focus, but give your patients a chance to speak! Next time, let them talk for just a little longer. Remember the famous saying: if speaking is silver, then listening is gold.

5. Other techniques
Maintain good eye-contact throughout your conversation, but not freakishly constant eye contact—which can be intimidating. Look away every so often like you would during a regular conversation. Lean in and use hand gestures as you explain things, to emphasize important points.

6. Involve the family always
Often, it's more important to talk to the family than the patient. This applies especially if the patient is elderly or disoriented. Don't move onto that next patient before pondering whether or not the family is in the loop. Give them a call from the bedside if you can. It may even save you a page or call later in the day!

7. Always ask open-ended questions
There's often more grey in medicine than black or white, and there's not always a “Yes” or “No” answer out there. A medical history is a story, not a robotic set of tick boxes. Open-ended questions typically start with words like “How”, “What”, “When”—or a phrase like “Tell me about that abdominal pain”. Closed-ended questions demand yes and no answers only, such as: “Do you have abdominal pain?” There is a way to balance these questions while staying focused and time efficient. Asking open-ended questions is also a way of promoting empathy and compassion in your discussion.

8. Avoid technical jargon
You are in the bubble of medicine, and it's easy to assume other people understand all the lingo. The reality is that they probably don't. Use as many layman's terms as possible. For example, avoid banding around words like “hemoglobin,” “hypotensive,” or “tachycardia” without putting some thought into whether the other person really comprehends what you are saying. Make things easy to understand. Instead of saying something like “your hemoglobin is low”, people may better visualize “your red cells are low”. Instead of “Your troponin level is elevated indicating myocardial ischemia,” it should be, “One of your heart blood tests is high that indicates strain or lack of oxygen to the heart.” If you want to get into more detail afterwards, you can. Use common sense and imagine you are talking to a family member who knows nothing about medicine. I'm always amazed whenever I overhear conversations between experienced doctors and their patients, and how many technical terms are used—even some that I would struggle to understand!

9. Always give a chance to ask questionsbr/>Make sure the patient understands everything you've told them. Never end a conversation without asking if they have any questions. Remember, this is their life on the line, so they should have questions! If there really isn't enough time, come back later.

10. Ending
Always finish your conversation on a positive note if possible. End with a statement of encouragement for the patient, such as: “You'll get through this just fine.” Words like that can mean a lot. Remember to always let them know how they can contact you again if they have any questions or concerns. Even though you may not be coming back to see them on that day, it's important the patient never gets the feeling that you are just “disappearing.” Also be considerate and leave the patient as you found them with things such as bed position and lighting.

So now that we've talked about 10 things that you should always do, here are three quick things that you shouldn't do:
1. Keep turning around and looking at the computer as you speak

This is highly annoying for the patient, who wants nothing more than a good old fashioned one-on-one conversation with their trusted doctor. It gives the impression that the doctor is distracted. Ideally, review information about the patient briefly before you walk into the room or they walk into the office, so that you are not meeting them completely “blind”.

2. Make it obvious you are in a hurry
You probably are in a rush as a doctor, it's the nature of the job. But try to avoid any body language cues like standing up or motioning towards the door, that may give this away.

3. Make it sound like any problem is trivial
If a patient tells you about something that's really bothering them, don't just pass it off. Be careful with completely ignoring that “painful finger.” Address it, even briefly, and reassure them that you'll help get it fixed even though it's not the main acute medical problem.

Doctor, communication is truly everything in health care. Treasure those few minutes you have with your patient, which they may have been waiting hours or days for. Be fully present, engaged, and as good a doctor as you can be. Those moments of personal connection and helping people will probably also be the most meaningful moments of your day as well. It's why I went to medical school, and probably why you did too. Make the patient feel like the center of your world and show them how devoted you are to their complete well-being. Because as Maya Angelou said: ”People will forget what you said, people will forget what you did, but people will never forget how you made them feel.”

Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.