Physician and patient communication are at the heart of empowering positive outcomes. As payment models shift from payment for activity to payment for outcomes how to be a more effective at communication should be at the top of physician lists to improve.
The basics of communication continue to consume the priorities of writers and old books about “how to” like How to Win Friends and Influence People continue to be best sellers. Regardless of how language and thought about communication have changed; the basics have remained.
Between physician and patient, there has never been a more important time to get communication right. While visiting a physician with my 88 year old uncle recently, several things struck me about communication and how it played a significant role in the visit. The advent of the EHR has changed the patient visit dynamics. During this particular visit, a nurse came in to get a full history. The laptop was placed on a counter and the nurse with her back to the patient, my father, began to ask questions.
Repeatedly, my uncle used non-verbal communication in reaction to a question......which, of course, the nurse did not see nor react. Like the question, “describe your pain”......there was a pause as my uncle shrugged his shoulders .......the nurse asked again, “describe your pain...on a scale of 1-10; 1 being no pain and 10 being unbearable.” Again, a shrug of the shoulders and a numeric response. The nurse was in her 20’s, and while technically proficient, didn’t realize she was speaking to the “no pain” generation patient. She could have gotten a significantly more realistic answer if she has been watching and reacting to the non-verbal communication.
Hint number 1: You can’t really communicate with a person you are not looking at directly.
As the nurse quickly ran through a list of diseases, asking was there a history, my uncle looked at me as she was going so fast, he really didn’t have time to answer before asking a second time.
Hint number 2: Don’t rush conversations especially with elderly patients. Give patients time to absorb the questions and to answer in their language.
Frequently, the nurse who was looking at the computer screen missed answers and had to ask for them to be repeated. Now, of course, giving the nurse the benefit of the doubt, learning to work with an EHR is no simple task and requires concentration and organized thoughts. New technology brings new challenges and workflow changes that must be learned over time. But....
Hint number 3: Pay attention to the patient. Actively listen.
This may also require one to ask clarifying questions. Actively try to understand not only what the patient says, but what they mean. At the conclusion of the nurse interview, she said to uncle, ”I’m going to repeat back what I heard you say was your chief reason for being here today. You tell me if you agree.” That was right on.....right out of how to effectively communicate 101.
Hint number 4: Repeat back what you believe you heard.
All this takes time and a focused effort to hear and be heard. But with outcomes depending upon patients understanding their roles and responsibility in this patient- provider dance, and revenue streams increasingly dependent on outcomes, isn’t it worth it?