What Do Patients Really Want?

Six patient pleasers in provider communications

In this edition of “The Wired Practice,” Ron Harman King of Vanguard Communications discusses how patient review patterns match studies published in major journals – both show that patients value clear communication and respect from their healthcare providers above clinical skills.
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Video Transcript

Today let’s once again examine the persistent question in healthcare, what do patients really want? In an attempt to answer that question, my colleagues and I spend many, many hours analyzing thousands and thousands of patients’ online reviews of doctors, hospitals and clinics. Over the years we’ve conducted these evaluations through our own special software, as well as by simply reading review after review.

Now, we can all agree that online reviews are not always the most scientific representation of universal patient experience. However, the serious student of social media nonetheless notices patterns that suggest verifiable trends in patients’ wants and needs. Bottom line, these patterns tend to very closely match the findings of scientific, peer-reviewed studies published in some of the most prestigious professional journals. I would say that the most salient match is the discovery that what patients probably want most is clear communications from their healthcare providers.

Interpersonal skills > clinical skills

For example, a study commissioned by The Wall Street Journal found that healthcare consumers place more importance on a doctor’s interpersonal skills than on clinical skills. Eight-five percent of those polled said being treated with dignity and respect is an extremely important quality in a doctor, and 84 percent also said the same about good listening skills.

In another documented example of the importance of interpersonal skills and communications, a review of H-CHAPS surveys found that in the hospital setting, two factors were linked to a decreased risk of readmission after discharge: doctors explaining information to patients and the listening skills of nurses.

Six suggestions on ways doctors can improve interpersonal skills

With this in mind, I’d like to offer a half-dozen perhaps obvious and not-so-obvious suggestions for improving interpersonal skills. Firstly, based on both research and anecdotal evidence from social media, if you’re running late for an appointment, acknowledge it and apologize for it immediately when you greet the patient – even when the delay is beyond your control, which it certainly will be much or most of the time. Even better, give a reason for the delay when appropriate, especially when a surgical complication or true emergency is the cause. And even better than that, make sure a staffer has communicated the delay to the patient before you’ve arrived.

Secondly, establish eye contact from the beginning of the appointment and maintain it as much as reasonably possible to indicate ongoing interest in the patient. Believe me, more than one online reviewer has complained mightily about his or her doctor looking more at a dictating recorder or a chart than the patient.

Thirdly, respond promptly either personally or by proxy to patient phone calls and especially to private messages via your patient portal. Yes, it’s true patient portals can lure you into the trap of unending online back-and-forth’s with patients if you’re not careful. At the same time, a distressed patient often just wants to hear back promptly from SOMEBODY – a doctor, a mid-level, a nurse, a medical assistant – SOMEBODY.

Fourthly, as a rule of thumb, strive to give the patient the floor 40 to 50 percent of the time you’re together. Now look, I’m not naïve. Even though I’m not a clinician, I am well aware of the overpowering time and budget crunches physicians face today. Sometimes it’s just not possible to review a patient’s chart and history, pose diagnostic questions, perform a physical exam, make new notes, write orders and prescriptions, convey medication instructions and side effects, AND everything else the patient needs to know such as giving follow-up directions to a nurse or medical assistant, and still let the patient take up half the conversation. On the other hand, if you strive for the 40/50 goal, you’ll likely move the patient-satisfaction needle a little farther. Moreover, research has shown that doctors who have achieved greater communications skills – including active listening – identify patients’ problems more accurately AND experience improved patient adherence to treatment and advice on behavioral and lifestyle changes.

Fifth, do not avoid discussion of the emotional and social impacts of patients’ health issues, even though you may feel inadequately prepared to deal with them. This is for the benefit of both patient and physician. A study published in the British medical journal The Lancet found that dealing with patients’ suffering is one of the three major causes of physician burnout, and that burnout was more prevalent among physicians insufficiently trained in communications and management skills.

Let the patient know he or she is the boss

And as for the impact on patients, I’ll never forget my first annual physical exam with my primary care provider a few years ago, not long after my wife died suddenly. His reaction to the news was simply to put down my chart, look at me gently, and say, “I can’t imagine the pain you’ve suffered. I would be devastated to lose my wife.” And then he let me talk it out without interruption or initiating the physical exam. That single reaction earned my lifelong loyalty to Dr. Schultz. The only way for me to switch PCPs now is for one of us to either move away or pass away.

Finally, perhaps the best way to end a patient encounter is to simply ask, “Is there anything else I can do for you today?” This simple question sends a strong signal to the patient that he or she is the boss, the one who matters most in this sacred relationship. It says not only are you a skilled physician and scientist, but that your true calling is in healthCARE.