Patient Care

10 Ways to Communicate Better with Patients

From personal satisfaction to better patient outcomes, there are lots of good reasons to improve your communication skills.

Judith Lee,
Contributing Editor

1. Stop Talking. Research indicates that physicians, in their rush to communicate, talk too much to patients. In one study, the physician interrupted 69 percent of patient interviews within the first 18 seconds. In 77 percent of these interviews, the patient’s reason for coming to the physician was not fully elicited.
   
   “Doctors talk too much because there’s so much to talk about,” says Dr. Clark. “But patients are not medical students. They don’t need all the facts. Some people need simple answers, and others just need comfort.”
   
   Listen. In the same study noted above, when the patient was allowed to speak without interruption, he or she spoke for more than two minutes. This is your opportunity to do what patients most need you to do.
   
   “Patients are a lot more satisfied if they can talk more, rather than less. You must listen carefully to learn the true needs of the patient,” Dr. Clark advises.
   
   
2. Look at the patient. Too many times, physicians are either writing in the chart or looking at it as they speak to the patient. Experts say you should always sit down and maintain eye contact with the patient. “I always sit directly across from the patient, and make eye-to-eye contact. This helps to slow things down, so the patient doesn’t feel rushed,” says Dr. Lee.
   
   
3. Get to know the patient. Many times, patients have been “trained” by physicians to wait to be questioned. Invite the patient to speak by asking some leading questions. If you haven’t met the patient before, allow a few moments to learn something about the patient, by saying, “I like to get to know my patients. What are some of your interests? What do you like to do to relax?”
   
   Even if you’ve met before, take a few minutes to break the ice. Ask the patient about hobbies or family activities. Instead of questions that lead to a yes or no answer, ask open-ended questions such as, “Where have you traveled to recently?” or “What have you been doing with your grandchildren?”
   
   Dr. Lee takes this a step further and conducts the full patient history himself. This gives him an opportunity to delve deeper into patient needs. “I actually save time by doing the history,” he says. “There are important questions that might not occur to a tech. Also, I’m able to get the patient to open up about his or her general well-being. Sometimes the patient doesn’t tell you the main complaint right away.”
   
   
4. Recognize cues. Studies of physician-patient interviews show that doctors often ignore patients’ nonverbal cues. Experts say that if you only respond to words, you’ll miss opportunities to communicate better.
   
   “Eighty percent of important social communication is nonverbal. You can tell when the patient is tuning you out if he gets quiet, or his eyes glaze over. This may be because he doesn’t understand you, or because you aren’t addressing his concerns,” says Dr. Clark.
   
   To get through to this patient, Mr. Mauksch suggests you take the direct approach: “Ask the patient, how well am I understanding your concerns? Am I addressing your biggest fears/difficulties?”
   
   Other important cues may be verbalized by the patient, but ignored by the doctor, because they aren’t related to medical facts. “The patient might say their spouse is very upset. If the physician ignores this, he or she is missing a chance to find out what’s really going on here. Maybe the spouse’s problem is the patient’s biggest problem,” explains Dr. Clark.
   
   
5. Address patient concerns. Physicians are trained to take charge of the situation, usually by creating an agenda and then following it through. While this may be efficient, it can fall short of addressing the patient’s true concerns.
   
   “It’s common for physicians to impose their agendas on patients instead of eliciting a full list of patient concerns and expectations. They tend to exclude patients from the decision-making, and create plans that patients may not be able or willing to follow. Physicians usually do not pick up on patient clues about important questions and fears because the physician is preoccupied with attending to his or her own agenda,” says Mr. Mauksch.
   
   He offers this alternate approach to encouraging patients to “open up” about what’s really concerning them:
   
   • Begin by asking what the patient’ concerns and expectations are for the time.
   
   • Create an agenda based on the patient’s concerns, and get the patient’s agreement on the agenda.
   
   • Involve the patient in treatment decision making.
   
   • Empathize with the patient’s situation, pain, confusion, etc.
   
   • Inquire more about the patient’s perspective on the illness to learn about personal, familial and cultural beliefs and related treatment ideas.
   
   
6. Reflect back what the patient says. One of the best ways to be sure you understand what another person says is to reflect back his or her words.
   
   “Especially in difficult moments, it helps to reflect back what the patient said: ‘So you’re a bit puzzled about what to do.’ Here, it’s best not to give more medical facts, but to let the patient talk some more. You will gain more information, and the patient will feel you are really listening,” says Dr. Clark.
   
   You can use the same technique to be sure the patient understands you. After you have given information or instructions, ask the patient to repeat his or her understanding.
   
   “Have the patient demonstrate comprehension by repeating what you said. The physician can ask: ‘Can you tell me the instructions we just went over to be sure I didn’t leave anything out?’ ” says Mr. Platt.
   
   
7. Speak in plain English. Physicians tend to use medical terms, rather than simpler language that patients understand. “Be patient, speak clearly and sometimes louder. Don’t use jargon or medico speak,” says Mr. Platt. “Instead of ‘You have glaucoma and here is the medication,’ you might say, ‘You have too much pressure inside the eye and we need to give you a medication that will lower this pressure.’ ”
   
   Dr. Lee says a valuable resource is patient information pamphlets, available from the American Academy of Ophthalmology. Look through these to pick up phrases that will be easy for patients to understand.
   
   “It’s part of our job to be teachers,” he says. “Doctors should read patient pamphlets and use these terms instead of medical terms. It’s wonderfully helpful, and patients appreciate it.”
   
   Another way to educate patients and answer their questions is to tell them what you’re doing during the exam. “I give the patient a running commentary such as ‘Now I’m testing your peripheral vision,’ ” says Dr. Lee. “Then I give feedback such as, ‘I don’t see any problems in the back of the eye,’ or ‘I don’t see any changes from last time,’ ” says Dr. Lee.
   
   He notes that this process elicits questions from patients that may lead to further information about their condition. Also, it saves time when he describes the findings.
   
   
8. Include the patient’s companion. If your patient brings along a relative or caregiver, be sure to include this person in your dialogue. Very often, this person is an important resource for the patient when he or she leaves the office.
   
   “There is always a reason that a patient is accompanied by someone else” notes Mr. Mauksch. “While it’s important to not devalue the patient’s autonomy, it is naive to ignore the influence that friends and family members have. Moreover, caregivers are invaluable allies of physicians. Those present in interviews who have caregiving responsibility may have their own set of questions.” He adds that even as you focus on the patient, you should be alert for opportunities to “care for the caregiver.”
   
   “Caregivers need a lot of support,” Mr. Mauksch says. “Not surprisingly, the risk of depression is much higher among family caregivers supporting people with chronic illnesses than the general population. So, ask the patient what the role of their companion is. And then ask the companion what his concerns are. Sometimes you may discover a conflict between patient and companion, which, if ignored, can complicate care.”
   
   
9. Use backup media. Because there is so much medical information, always use backup media to educate the patient before the exam, or to reinforce what you said after the patient encounter is over.
   
   A picture is worth a thousand words. And a well-made video gives consistent education. “Besides, we are visual creatures, and studies have shown increased retention when pictures and sound are used,” says Mr. Platt.
   
   Dr. Lee gets additional mileage out of those patient pamphlets available from the AAO. “We always hand the appropriate brochure or brochures to patients as they leave. Then they will have something to refer to, and I know the same terminology is used as I already used in my conversation,” he says.
   
10. Give enough time. Even though most physicians are pressured to see more patients in less time, experts advise you to use your best judgment when scheduling patients. Allowing enough time to communicate well will enable you to be a better doctor, and will increase patient satisfaction.
    
    “You cannot do this job without enough time for each patient,” warns Dr. Clark. “You will stop being effective, and you will burn out.” He also notes that physicians who are interested in improving their communication skills must devote time to this learning process—just as they would for a new surgical technique or procedure.
    
    “This is like learning a new language,” Dr. Clark says. “There is a certain grammar, syntax and use of words. Most physicians are not beginners at communicating; they have many skills. But they should never stop practicing to improve their skills.”
    
    Dr. Lee believes that giving more time to each patient will lead to greater practice success, not less. “We have one of the busiest practices in Oakland. This is due to word-of-mouth referral, one patient recommending us to another patient,” Dr. Lee says. He believes that ophthalmologists and all physicians today have a tendency to underestimate the importance of what they do, and the value of their communication with patients.
    
    “Because of the pressures of modern health care, we tend to undervalue our worth to society,” says Dr. Lee. “What we do is mundane to us, but not to our patients. Our worth is a bit more than what you pay the plumber. We need to renew our pride in our profession. What we do makes a real difference in people’s lives.” 

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