Doctor Communication Skills Are the Heart of Bedside Manner

 

For a good patient experience, employ empathy, mindfulness and other communication skills

Good bedside manner is critical for your patients’ satisfaction and for yours. How you communicate is a very large part of that experience. The goals of doctor-patient communication are a good interpersonal relationship, including the patient in the decision making and a thorough, well-understood exchange of information.

Without a doubt, patients also contribute to communication issues or break-downs, whether it be unreal expectations or lack of participation. Patient resistance is counted as a factor in poor doctor-patient communication in a study cited by the National Institutes of Health that also offers these causes of poor doctor communication:

• Deteriorating communication skills.
• Doctor avoidance behavior in discussion of problems with social and emotional impact for the patient.
• Discouraging collaboration with the patient, which can result in the patient not disclosing important information.

Not appearing open to collaboration can start with the medical interview, which is a primary way a doctor and patient build a good interpersonal relationship. It enables the physician to show compassion and be responsive to the patient’s needs. Following are eight concepts for doctor communication skills to use with patients that can strengthen relationships, bringing benefit to patients and your practice.

Enhance patient centered care by eliciting the person’s agenda

How you communicate is at the heart of your patient’s first impression of you. But that impression starts out on the wrong foot when the physician does not elicit the patient’s concerns first. One study in the Journal of General Internal Medicine shows that doctors only elicit the patient’s agenda in 36% of encounters.

And when they do, the physician will interrupt the patient in a median of 11 seconds after asking that question! This does not allow the patient to properly express the magnitude of the problem and can result in the patient feeling disrespected. That’s not a good start toward patient centered care. Try to avoid interrupting the patient in the first exchange, but if you need to, certainly don’t interrupt after 11 seconds. Give the patient ample time to know you are listening.

The first step in respectful patient engagement

Here’s an example of first eliciting patient concerns. “Good to see you Mr. Amis,” you say while shaking his hand and looking him in the eye. “Tell me what concerns you have I can help with. I see you told the nurse that your shoulder pain is flaring up recently. Can you give me more details?”

Mr. Amis and his concerns are immediately the center of attention. He’s going to be forthcoming. Before you say anything, you should know his name, how to pronounce it (ask him if you are unsure) and address him as Mr., unless he suggests otherwise. If there’s a family member present, address that person similarly. These little formalities of engagement are a sign of respect patients often appreciate.

Showing empathy shows your good bedside manners

Being empathetic can do wonders for how patients feel when leaving your office, even when they receive poor news. Start when you respond to your patient’s presentation of the problem. It’s not just an empathy for medical or emotional concerns or issues that present. Going back to the Mr. Amis example, assume he has had to wait more than a few minutes for you to see him. Acknowledge that, don’t ignore it. You can be sure it is on his mind. You might amend the above conversation in the following manner.

“Good to see you Mr. Amis. I’m sorry to keep you waiting but I had a couple of complications come up in my schedule. Let’s get you taken care of so you can get on with your day. What brings you in to see me today?” That simple acknowledgement of the obvious shows you empathize with your patient and respect his time. This can influence the way the whole encounter goes.

Taking charge of the conversation is a necessary communication skill for a doctor

While your communication needs to be open and a two-way street with the patient, you also need to guide the conversation. Sometimes you need to interrupt, because patients can be long-winded and go off on tangents. Do so with consideration and get the conversation back on the topic at hand.

Say your patient keeps harping on his golf handicap and losing money with his partners, you can take charge like this: “I can understand how the pain flare up might affect your golf score, Mr. Amis, but we need to focus on how to keep the pain down, not just your score. Do you feel that the over-the-counter medication is still working as it did before?”

Taking charge of the conversation also means ensuring patients have all the information they need and fully understand what was discussed before they leave the office. This not only ensures they can make informed medical decisions but will likely save a lot of time in follow-up or clearing up miscommunication later.

Medical mindfulness communication skills

Show you are listening to Mr. Amis. This is part of practicing mindfulness with the patient by being present in the moment. It can take some balancing.

For example, you will probably need to enter information in the EMR. If you can, arrange it so you can see Mr. Amis and the screen at the same time. Look up from the screen at him in between entering notes, even if you have to turn to make that eye contact.

Throughout your conversation with Mr. Amis, make sure to speak in everyday language that avoids medical jargon as it shows you are sharing the present moment with him. It’s much more likely that he will both understand and remember your advice and the reason behind the questions you may ask him.

What’s your body language saying?

Looking over your screen to address the patient is an aspect of body language, which is an important part of your communication skills. Want to make the patient feel rushed? Stand up throughout the encounter.

Sitting is a simple act that can make the patient feel more comfortable. Your facial expressions, eye contact, gestures, body posture and touch communicate a lot, perhaps as much as your words. Prolonged smiling is a positive signal, crossing arms is a negative.

Tone of voice is another element of body language you should pay attention to. So is the way you speak: if you speak quietly and look down frequently, your patient will interpret this as reluctance to engage on your part. Being perceptive of your patient’s body language is another important element of nonverbal doctor-patient communication.

Try the teach back method for better patient engagement

Throughout your dialog with patients, you should assess whether or not they are understanding what you are imparting. A good way to make certain of that is at the end of the visit with a recap, which some refer to as the teach back method, or teach back moment. Here’s a good example of this communication skill.

“I think we have a good plan, Mr. Amis.

• To recap, we’re going to stick with your current over-the-counter pain medication as needed.
• Try to do more of the warm up and starching exercises I gave you, because that can make it easier on your shoulder during any activity.
• You’re going to work on adjusting your golf swing by using your back to swing your arms instead of your shoulders and don’t extend the shoulders as much in your follow through to take some pressure off your shoulders.
• And utilize the ice sooner when shoulder inflammation and pain flare up.”

Let patients know you care when they become upset

The more troubling the situation, the more you need good communications skills. If your patient becomes upset and emotional, don’t turn away or try to let it pass on its own. Acknowledge the upset, let the patient know you care and validate his or her emotions.

Give the patient a little time to process those emotions. This also applies to delivering bad news, which is difficult for the patient and the physician.

Identify pitfalls that can sabotage communication skills

It’s also helpful to know the factors that may put limitations on the quality of communications with patients. These include time constraints on the visit, speech or language difficulties, patient illness, altered mental state, psychological or emotional distress, and cultural, racial or gender differences.

There are a lot of aspects to skillful communications. You may be better at some than others, but trying to always improve your end of the conversation can go a long way in making sure that doctor/patient and patient/doctor experiences align.