"Medicine is an art whose magic and creative ability have long been recognized as residing in the interpersonal aspects of patient-physician relationship.”(1)
The principles of patient-centered medicine date back to Hippocrates and the ancient Greek school of Cos.(2) However, patient-centered medicine has not always been standard practice, nor has honest, open communication between doctor and patient. For example, in the 1950s, ’60s, and ’70s, many doctors considered it inhumane and detrimental to disclose a bad prognosis to terminal cancer patients.(3)
Today, the health consumer movement has led to the shared-decision model, putting the patient at the center of doctor-patient communication. Unfortunately, medical schools typically don’t include classes on communicating with patients, and doctor-patient communication has not necessarily improved.
Consider these two examples of sub-par communications skills.
A patient asks for additional information or some credible websites to learn more about their medical problem. The doctor responds, “If you don’t trust me, you should go elsewhere.”
The doctor operates on a patient and leaves the surgical area without speaking with the patient’s family. The family asks the secretary in the surgical reception area if they can talk to the doctor and learns that the doctor is in his office but won’t talk to the family.
These two doctors have lost rapport with their patients and patients’ families. This may lead to a loss of confidence and trust in the physician, which might impact outcomes and certainly places the doctor at increased risk of litigation.
Physicians don’t always recognize this lack of communication skills on their part. In fact, studies have shown that doctors overestimate their ability to communicate with their patients.(4) In one study, nearly 75% of the orthopedic surgeons surveyed believed that they communicated satisfactorily with their patients. Yet, only 21% of the patients reported satisfactory communication with their doctors.
Benefits of Enhanced Communication
Patient surveys have consistently shown that patients want better communication with their doctors.(6) Good doctor-patient communication can help enhance patients’ emotions, facilitate understanding of medical information, and better identify patients’ needs, perceptions, and expectations.
Patients reporting good communication with their doctor are more likely to be satisfied with their care and more likely to share pertinent information for accurate diagnosis of their problems and comply with the doctor’s advice.(5) Patients’ understanding of the nature of the treatment and the need for follow-up is strongly associated with their recovery.
Some studies have observed the connection between good doctor-patient communication and a decreased length of hospital stay — and, consequently, the reduced cost of individual medical visits and fewer referrals.(6) In addition, satisfied patients are less likely to lodge complaints or initiate malpractice suits.(7)
Other benefits to doctors include greater job satisfaction, enhanced online reputation on medical review sites, less work-related stress, and reduced risk of burnout.(8)
The Challenges to Effective Communication
A few of the many barriers to good communication in the doctor-patient relationship include patients’ anxiety and fear, doctors’ burden of work, and unrealistic patient expectations.(9) The stress of medical training and workload, particularly during internship and residency, also reduces empathy as physicians substitute tests and procedures for doctor-patient communication.(10)
Doctors may avoid discussing the emotional and social impact of patients’ problems because it makes them uncomfortable talking about them or they are limited by time. This avoidance tends to increase patients’ distress and may result in patients being unwilling to disclose problems, which could delay and adversely affect their recovery.(11,12)
When physicians discourage patients from voicing their concerns and expectations and requesting more information, as described in the scenario above, they deter patients from being part of the conversation.
Enhancing Patient-Doctor Communication
Patients who are happy with their healthcare professionals share a common sentiment: “I feel heard and understood.” How do we become those professionals and ensure we connect and communicate well with our patients? Here are some suggestions.
Break the ice. Don’t start the dialog with a new patient by launching into their medical problem. Instead, ask an open-ended question about what they do, where they live, where they have traveled, their hobbies, or their families. This allows you to focus on the whole patient rather than an organ system.
Communicate by listening. One study measured the average time before a physician interrupted a patient who was speaking: 16 seconds.(13) This abbreviated time hardly qualifies as good listening.
When patients share their symptoms, doctors should show curiosity and concern. Ask clarifying questions. Ask how the symptom or problem is impacting their lives. Avoid asking questions that are answered with just yes or no.
Focused or active listening means looking eyeball-to-eyeball with the patient, not looking at the computer. If you are multitasking and checking your cell phone, you can’t convince a patient that you are listening.
Also, inform your staff that when you are with a patient, you are only to be interrupted if there is an emergency, such as a call from the emergency room, the operating room, or the intensive care unit.
Check your “doctor speak” at the door. There are several studies about common phrases healthcare providers use and how often patients do not understand them. For example, only 9% of patients understood what was meant when asked if they had been febrile. Only 2% understood what was meant by “an occult infection.” Only 21% understood that “your x-ray findings were quite impressive” was bad news.(14)
Other terms physicians use that most patients need help understanding include bilateral, systemic, and evidenced-based. As you explain these terms to patients, check back with them frequently to ensure they understand your explanation.
Be honest and sincere. When the diagnosis is uncertain, be honest with the patient and share why you think it is wise not to initiate definitive treatment until more information is available. This increases patients’ trust because it indicates that you know you don’t have an answer for everything and are willing to wait until you do.
Another effective way to connect with your patients is to ask what they think is causing their symptoms. The answer to this question may give insight into patients’ fears. You can discuss their worries, even if it isn’t something you are considering. By knowing what they fear, you can reassure them when appropriate.
Welcome questions. Effective communication includes answering the patient’s questions before concluding the encounter. This can be facilitated by giving the patients a 3 × 5 card to write down what questions they would like answered on their visit. Don’t conclude the session until all the patient’s questions have been answered. This avoids the uncomfortable situation where your hand is on the doorknob and the patient has just one more question.
Bottom Line
Patients’ No. 1 complaint about their healthcare is having to wait to obtain an appointment and then waiting in the reception area to see the doctor. The next most common complaint is doctors’ failure to communicate effectively with their patients.
Interestingly, most complaints about doctors are related to communication issues rather than clinical competency. Of course, patients want doctors to diagnose and treat their illnesses, but they also want good communicators. Because words are the primary means we use to communicate with our patients, let’s try to get those words right.
References
Ha JF, Longnecker N. Doctor-Patient Communication: A Review. Ochsner Journal. 2010;10(1):38–43.
Stewart M, Brown JB, Donner A, et al. The Impact of Patient-Centered Care on Outcomes. J Fam Pract. 2000;49(9):796–804.
Baile WF, Buckman R, Lenzi R, et al. SPIKES—A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer. Oncologist. 2000;5(4):302–311.
Stewart MA. Effective Physician-Patient Communication and Health Outcomes: A Review. CMAJ. 1995;152(9):1423–1433.
Aremu TO, Oluwole OE, Adeyinka KO, Schommer JC. Medication Adherence and Compliance: Recipe for Improving Patient Outcomes. Pharmacy. 2022;10(5):106.
Little P, Everitt H, Williamson I, et al. Observational Study of Effect of Patient Centredness and Positive Approach on Outcomes of General Practice Consultations. BMJ. 2001;323(7318):908–911.
Maguire P, Pitceathly C. Key Communication Skills and How to Acquire Them. BMJ. 2002;325(7366):697–700.
Schneider BJ, Ehsanian R. Schmidt A., et al. The Effect of Patient Satisfaction Scores on Physician Job Satisfaction and Burnout. Future Science OA. 2020;7(1):FSO657.
Watrelot AA, Tanos V, Grimbizis G, et al. From Complication to Litigation: The Importance of Non-Technical Skills in the Management of Complications. Facts, Views & Vision in ObGyn. 2020;12(2):133.
Neumann M, Edelhäuser F, Tauschel D, et al. (2011). Empathy Decline and Its Reasons: A Systematic Review of Studies with Medical Students and Residents. Acad Med. 2011;86(8):996–1009.
Maguire P, Pitceathly C. Key Communication Skills and How to Acquire Them. BMJ. 2002;325(7366):697–700.
DiMatteo MR. The Role of the Physician in the Emerging Health Care Environment. West J Med. 1998;168(5):328–333.
Hartzband P, Groopman J. (2020). Physician Burnout, Interrupted. NEJM. 2020;382(26): 2485–2487.
Gotlieb R, Praska C, Hendrickson MA, et al. Accuracy in Patient Understanding of Common Medical Phrases. JAMA Netw Open. 2022;5(11):e2242972.