Effective Doctor-Patient Communication

EFFECTIVE DOCTOR PATIENT COMMUNICATIONS

INTRODUCTION

1. Patients who rate communication with their physicians as excellent are four times more likely to believe they have received excellent health care than those who do not. Also patients who like the way their physician communicates with them are more likely to comply with their doctor's recommendations and less likely to sue for medical malpractice in the event of a negative outcome.

2. Good doctor-patient communication is influenced by a combination of physician attitudes, behaviours, and interpersonal skills. This paper integrates practical suggestions for enhancing doctor-patient communication as gleaned from a number of excellent guides on this topic.

METHODS OF IMPROVING
COMMUNICATIONS – THE DOCTORS ROLE

3. The onus of improving communications is not only the doctors’ responsibility. The patient also has to contribute. Methods that a doctor can undertake to improve communications areas discussed in the following paragraphs.

Show Empathy and Respect

4. Empathy is conveyed when you behave in ways that let your patients know that you care about what they are experiencing. Even a simple statement such as "I'm sorry that you're having these problems" goes a long way in conveying empathy. Some important points a doctor must keep in mind and apply at all times are as follows: -

(a) Practice putting yourself in the patient's shoes.

(b) Assume the stance of "servant," and remember that showing the patient compassion and understanding is an important part of your job as a physician.

(c) Look for reasons behind a patient's problematic behaviour.

(d) Pay close attention to nonverbal cues about how the patient is feeling.

5. A few commonsense courtesies will convey to patients that you respect them as people. Before beginning a medical examination, introduce yourself and everyone else in the room, and orient the patient to what you are about to do. Question patients thoroughly, letting them know that you are concerned about their medical symptoms and their general well-being. When time allows, ask about problems of daily living, relationships, and feelings. Often, a simple "How are you doing otherwise?" will suffice.

Clarity Conveys Competence

6. In the eyes of patients, competent physicians are those who are able to explain medical matters in terms the patients can understand. Nearly 50% of college-educated patients say they leave their doctors' offices not clear about some aspect of their care. Patients will not follow through with recommendations they do not understand. Give clear, complete, step-by-step instructions, and never use excessive technical jargon.

Learn to Listen

7. Would your patients describe you as being a good listener? If you do not know how your patients would answer this question, consider asking them. A recent survey of 947 medical patients conducted in America indicated that 93% of patients who stated that their doctor was a good listener also indicated high levels of confidence in their doctor's advice; in contrast, only approximately 10% of those who rated their doctors as poor listeners expressed confidence in them.

Develop Cultural Competence

8. Extraordinary doctors avoid making assumptions about their patients based on race, ethnicity, gender, sexual orientation, socioeconomic status, or even past encounters. In short, extraordinary doctors are culturally competent. Competence refers to the ability to understand and work with patients whose beliefs, values, and histories are significantly different from your own.

9. Research has suggested that medical education may not promote cultural sensitivity. For example, 62% of medical students report that they have been exposed to antigay comments during medical training, and 50% of non-white medical students report experiencing racial or ethnic slurs during training. Remaining open to cultural differences is made difficult by the fact that, as the training years unfold, many students and residents grow more cynical and self-protective in their attitudes toward patients.

10. What does it take to be a culturally competent physician? In some cases, cultural competence requires special language skills. More often, it requires an attitude of curiosity, acceptance, and warmth that will lead you to acquire specific knowledge about your patients. Some pointers to be remembered are: - (a) Don't make assumptions about the patient based on appearance or surname.

(b) Listen carefully to the patient.

(c) Become familiar with specific cultural health beliefs and folk remedies, and, where appropriate, incorporate them into treatment recommendations.

(d) Show a desire to connect with the patient, even if a language or lifestyle barrier exists.

(e) If a language barrier exists, use an interpreter if possible; try to learn at least rudimentary phrases in the patient's language; and have patience with communication difficulties.

(f) Confirm patient understanding and agreement before proceeding.

Learn the Art of Delivering Bad News with Compassion

11. For patients, much of what physicians have to say falls into the category of "bad news." Excellent guidelines for learning the art of conveying bad news do exist. A few tips worth remembering are as follows: -
(a) Accept that your Communication Style does Matter. Research has shown that a physician's communication style when delivering bad news influences patient anxiety, depression, hope, decision making, and adjustment to illness. A study of 100 patients with breast cancer surveyed 6 months after surgery suggested that adjustment to illness correlated with physician behaviour during the diagnostic interview. In fact, this study indicated that, according to the patients, the physician's caring attitude was more important than the information given during the encounter.
In another study, patients who perceived that the diagnostic delivery session was handled poorly were twice as likely to be depressed or anxious than were patients who expressed satisfaction with their doctor's style of delivering the bad news.
(b) When in Doubt, Ask the Patient. Research has shown that, among physicians who rated their own communication and understanding of their patients as being highly satisfactory, only 1 in 5 were able to reliably assess patient distress (anxiety and depression) resulting from bad news. It is wise to inquire as to how the patient is feeling about the news you are delivering.

(c) Don't Forget the Basics. Even though it is difficult to do, try not to become desensitised to patients' anxieties about their medical conditions. Remember the old adage: "The only 'minor' surgery is surgery someone else is having." Remember that patients vary widely in the extent to which they want basic rather than detailed information. The best way to determine how much information is enough is to ask the patient. Some tips to be kept in mind when delivering bad news are: -

(i) Don't be too blunt, but do honestly discuss the patient's condition and
prognosis.

(ii) Don't have the discussion over the phone or in a place not appropriate for a serious conversation.

(iii) Do convey a sense of hope, even if only for keeping the patient comfortable. For example, you may say something like, "I'm sorry that we don't know of any treatment for your condition that has proven value. However, there's always hope that something may be developed. In the meantime, we do have many ways to help you cope with what is to come."

(d) Make Time. Make time for patients to discuss their personal values and goals, rather than spending the bulk of the visit talking. Encourage patients to share any worries, then listen quietly. You may say, "Tell me more about what you are most afraid of with this illness."

(e) Clarify. Upsetting news stirs emotions that interfere with the ability to process complex information. Ask, "Is this making sense to you?" and, "Is there something else you would like to know about?"

Follow-Up

12. The emotional course that comes with bad news differs for doctors and their patients. Your stress level is likely to build gradually as you anticipate the patient encounter and peak during the actual discussion. As soon as the discussion is over, you are likely to feel relief from this anxiety, even though it may take several days for your emotions to truly calm. The patient's stress, however, will peak some time after you deliver the unwanted news. This is an important point. After being given bad news, most patients—even those who take the news without a show of emotions—want to discuss ramifications of your diagnosis. Unfortunately, only approximately 35% of patients report that they are given opportunities to have such follow-up discussions with their physicians.

Be Humble and Accessible

13. Patients say that they trust physicians who admit when they do not know all the answers, apologize when they are late, and show a desire to continue learning. Never confuse being busy with being important. When you are not reasonably available to patients, their confidence in your ability to take care of them dwindles.

METHODS OF IMPROVING COMMUNICATIONS – THE PATIENTS ROLE

14.
As stated earlier the patient also has to contribute towards improving communications. The patient and a doctor have a special partnership. Working together, both of them can solve medical problems and follow a plan to keep the patient in good health. It is a good idea to make a list of questions or concerns a patient has before meeting the doctor. A patient can find out how much he or she knows about good doctor-patient communication by taking the quiz placed at Appendix. The quiz is based on information from the National Institute on Aging. Answers require to be in true/false. Comments on the answers are at the end of the
quiz.

CONCLUSION

15. Effective doctor-patient communications stems naturally from a caring, respectful, and inquisitive attitude. It results from cumulative experiences with a diverse patient population or from a learned set of communication skills. Knowing how to build positive relationships with patients is a skill possessed by every exceptional doctor.

16. Good communication is not just about a doctor's bedside manner. It is fundamental to our central goal of redesigning services around the perspective of the patient. It involves patients being more involved in decisions about their own care and in active planning of services more generally. It is only by listening to patients that a genuinely responsive health service can develop. This process starts with each doctor- patient consultation. Poor communication leads to poor clinical practice and poorer outcomes for patients.

17. It is never easy breaking the news that someone has a life threatening illness. Doctors, therefore, need to be prepared and trained to deal with difficult situations to help distraught patients and, where appropriate, their family members.

18. Medical schools should equip their students with undergraduate training in communication skills and should also be taught how to deal with patients in a variety of situations throughout their course.

19. Unlike current medical undergraduates, many consultants have not been taught communications skills. In recent years, however, patients have become much better informed through the Internet and other media and seek more active involvement in their treatment
20. Better communications can yield huge benefits ranging from fewer clinical errors and patient complaints, more accurate diagnosis and care, to reducing avoidable stress on both patients and clinicians and the level of medical litigation