How to Communicate With Patients to Get Better Outcomes

By Nancy Wurtzel

Today’s clinicians will conduct between 120,000- 150,000 patient interviews during a typical career. However, during those important interviews, doctors on average let patients talk about their symptoms for only 18 seconds before interrupting.

Is it any surprise when patients report they are not being heard or understood by their physician?

Communication between doctors and patients has never been more critical. In fact, back-and-forth dialogue is so vital to successful care that it is now often referred to as the “talking cure.”  This “talking cure” has been shown to reduce pain and improve blood pressure readings along with other positive effects.

According to a 2015 review of reports by the Joint Commission, communication failure – not a doctor’s technical skill – was at the root of over 70 percent of serious adverse health outcomes.

In other words, a provider can diagnose with accuracy and prescribe a course of therapy, however if the patient doesn’t understand or buy into it, there is a significant chance therapy won’t be successful.

Nirmal Joshi, chief medical officer for Pinnacle Health System, highlighted this information and more in The New York Times op-ed section.  Joshi wrote, “…we need to move away from the perception that social skills and better communication are a kind of optional extra for doctors. A good bedside manner is simply good medicine.”

A failure to communicate effectively with patients can also be costly.

“Research shows that when doctors don’t listen to patients, they miss important health cues and misdiagnose illness,” wrote journalist Laura Landro in the Wall Street Journal. “Meanwhile, patients who don’t understand what their doctors’ say, fail to follow their regimens, leading to preventable hospitalizations, complications and poor outcomes.  And a breakdown in physician-patient communication is cited in 40% or more of malpractice suits.”

Here are some ideas for improving communication between physicians and patients:

Make a Meaningful Connection:  The physician who sits at or close to the patient’s eye level, looks patients in the eye, and allows the conversation to be back-and-forth will be judged to have better communication skills. Showing understanding, patience and empathy will further bond the patient to his or her provider.

More Information, But Not Always Better Educated:  The internet means patients have access to almost unlimited information.  However, this does not always mean they will be better educated, and there is the danger of self-diagnosing and treatment. Clarify any misinformation or facts for the patient, but avoid a lengthy lecture.

Monitor for Levels of Understanding:  Watch patients for nonverbal communication signals.  This is especially important when it comes to care management. Physicians often believe they are clear in their care management orders. However, just to make sure, ask patients to “teach back” what you are prescribing. The goal is not to put the patient “on the spot,” but rather to determine the patient’s level of understanding.  Additionally, physicians are encouraged to present all care orders in writing.

Achieve Patient Buy-In:  Medical care is a partnership, not a one-sided relationship.  Patients expect explanations of therapies and medications, and they will want to play a role in their care.  Some patients will push back, so physicians must be prepared to negotiate for a better outcome.

Another powerful communication system gaining momentum is a doctor/patient model known as The Four Habits.

Created in the 1990s by Terry Stein, an Internal Medicine physician at Kaiser Permanente in Northern California, The Four Habits teaches health care providers how to create rapport with patients, elicit their views, and exhibit empathy.  Additionally, it gauges the patient’s ability to follow a treatment regimen.

The Four Habits are as follows:

1) Invest in the beginning of the visit and build rapport

2) Elicit the patient’s perspective

3) Demonstrate empathy

4) Involve patients at the end of the visit in designing a treatment plan.

“Early in my career I saw that I needed a repertoire of skills beyond my medical know-how to do a good job,” said Stein. “We all need to recognize each other as people and be sensitive to our patients. Sometimes it’s not easy given the number of tasks and many aspects of a patient’s health we want to address during a visit. Sometimes we have to be reminded.”