Effective physician-patient communication that builds trust and a shared sense of responsibility for the patient’s care is an increasingly important skill for physicians. Doctors whose communication fosters patient engagement has been linked to a wide range of benefits, from increased patient satisfaction, trust and higher quality of care to better patient adherence to treatment and improved physical outcomes. Communication skills are especially important in a hospital setting, which patients often perceive as more impersonal than a visit to their primary care physician’s office.
The challenge is that while the need to involve patients in decisions about their own care continues to grow in importance, the current health care environment – including shorter hospital stays, more complex medical care and a drive for efficiency – makes it harder to achieved good communication among providers, patients and family members.
The Negative Effects of Poor Physician Communication on Patient Experiences … and Outcomes
A 2015 study published in PLOS ONE synthesized qualitative studies exploring patients’ experiences in communicating with a primary care physician to identify the determinants of positive and negative experiences in physician-patient communication and their subsequent outcomes. It found that, overall, primary care physicians’ communications create more negative than positive patient experiences. Patients report that physicians usually lead consultations and sometimes in a paternalistic manner – deciding on the treatment plan without engaging the patient in a conversation about care decisions, asking too few questions or too many closed-ended question, and rushing through explanations of the patients’ illnesses while using complicated, unfamiliar medical jargon. Doctors often orient conversations toward physical symptoms without leaving room to discuss psychosocial aspects related to the condition. As a result, patients say they feel powerless, vulnerable and intimidated and, therefore, less likely to engage in their own care decisions by asking questions or volunteering psychosocial or other information that might affect their diagnosis or treatment. Those who attempt to address psychosocial issues proactively report being dismissed.
Patients say these negative experiences leave them feeling not only helpless, frustrated, unheard and unrecognized but also unmotivated to comply with their treatment plans.
While this study focused specifically on primary care doctors, these problems can be exacerbated in a hospital setting, where a physician-patient relationship may not have been established.
Communication Skills That Promote Patient Engagement
Patients also shared the communication-related skills they value most in physicians:
- Careful listening.
- An open mind.
- A genuine interest in the patient.
- Willingness to ask questions and initiate conversations.
- Investing time and effort to educate patients and make sure they understand the illness.
These skills are key to fostering collaborative, two-way communication and building trust and mutual respect – things that can provide important contextual information and enable doctors to do a better job of tailoring care and fostering patient engagement.
Cultural Barriers to Effective Communication
Ultimately, whether patients experience a physician’s communication with them as positive or negative is heavily influenced by the context of a patient’s individual background and values. Some of the ethnic minority patients report experiencing additional communication difficulties resulting from language barriers, discrimination, differences in values and beliefs, and acculturation-related issues.
The study offers several examples of how acculturation affects physician-patient communication. One such example is that Hispanic migrants to the U.S. say they need to develop a warm relationship with their physicians before they feel safe sharing private information, while U.S.-born Hispanics attach less importance to developing warm relationships with their doctors because they appear to understand that the physician’s primary role in this country is to heal.
Interestingly, patients who need to consult with informal interpreters during medical visits say those consultations make them feel embarrassed, guilty and uncomfortable. And, not surprisingly, the presence of an informal interpreter not only inhibits patients from discussing sensitive or mental health topics but also makes disclosing intimate information difficult or impossible.
Six Ways to Improve Physician-Patient Communication and Engagement
Solicit Relevant Psychosocial Contexts
Encourage patients to talk about psychosocial factors that might be related to their condition. Try to provide a nonjudgmental atmosphere to help make them comfortable talking about difficult personal issues.
Tailor Communications to Cultural Contexts
Develop a cultural awareness and understanding of the populations you serve and tailor communications appropriately to each patient’s cultural, values- and beliefs-based context to avoid inadvertently giving offense or causing mistrust.
Educate Patients on Care Best Practices
In a recent article in MedPage Today, Dr. Catherine Polera, chief medical officer for Sheridan’s Emergency Medicine division, describes how she uses effective communicate to bridge gaps in patient expectations. For example, patients who are diagnosed with bronchitis often expect a prescription for antibiotics, yet acute bronchitis is usually viral and, therefore, usually should not be treated with antibiotics. She finds that explaining the reason for her decision not to prescribe an antibiotic in that situation, using easy to understand language and showing patients evidence that supports her decision – using online sources they trust – helps educate patients and increase their satisfaction with the care she provides.
Educate Patients About Responsible Antibiotic Stewardship
This is also an opportunity to educate patients not only on their diagnosis but also on the evolution of antibiotic-resistant superbugs and the importance of responsible antibiotic stewardship on the part of both doctors and patients to slow that evolution.
Provide Compassionate, Personalized Care and Reassurance
A great example is radiologists Dr. Lynda Frye and Dr. Orna Hadar at the Jupiter Medical Center’s Margaret W. Niedland Breast Center, who understand that breast cancer screening is often an intimate, stressful experience for patients. To engage patients in their own care, both these physicians build patient relationships based on honest communication and trust, providing timely information and reassurance during what can be a frightening time. They read mammogram imaging immediately and discuss the results with patients. They thereby connect directly with patients and eliminate the dreaded callback to inform patients that they need to take more images. If more images or biopsies are necessary, Dr. Frye and Dr. Hadar will order them at that appointment. Additionally, they insist on delivering news to patients themselves to demonstrate their total commitment to the patient. Their compassionate, personalized care builds trust and encourages their patients to return for annual breast cancer screenings.
Provide Online Information Resources to Educate Patients and Set Expectations
Providing easily accessible, curated, topic-specific information can help reduce patients’ anxiety and properly set their expectations about medical conditions, recommended treatments and upcoming procedures. A good example of the latter is Sheridan’s Anesthesia Patient Education Portal, which not only explains the different types of anesthesia, the roles of anesthesia care team members, and what patients should expect before, during and after surgery, but also provides guidance on the types of questions patients may want to ask the anesthesiologist during the preoperative evaluation. Setting expectations, particularly around pain management, also can have a positive impact on patient experience and satisfaction.