Clinician-Patient Communications

One of the most important keys to a successful relationship between doctor and patient is good communication. Effective communication on the physician’s part involves excellent listening skills, the knack for ferreting out pertinent details and the ability to share information with and educate the patient. Atlanta Medicine spoke with two local physicians who have expertise in the field of clinician-patient communication, and they shared some of their insights here.

Good Communication is Part of Patient-centered Care

“An important part of practicing patient-centered care is eliciting helpful information from the patient,” says Dimitri Cassimatis, M.D., a practicing cardiologist who also serves as Associate Professor of Medicine at Emory University and Director of the Coronary Care Unit at Emory University Hospital Midtown. “Good communication is a tool the physician uses to help the patient get the most out of his or her visit.”

Cassimatis has four main goals that he says will help physicians communicate with patients in order to provide the most effective treatment:

1. Make it a priority to gain insight into the person and an understanding of the concerns they bring to their appointment or to the hospital. Ask questions, and listen to the answers to learn about the patient’s background, including family, home life, job and overall lifestyle.

2. Making the diagnosis comes from listening. Know the right questions to ask to spur a patient into telling you more than they realize they have to tell you, including all the symptoms they may or may not be having. Ask open-ended questions such as “Tell me how you’re feeling” or “Tell me more about your concerns,” as opposed to “Are you having chest pain or arm pain or shortness of breath?” But also know when to ask those direct questions. And summarize to the patient what you heard them say so that they feel you truly listened and have an opportunity to add concerns they may have forgotten.

3. Communicate to educate the patient. Once you’ve made a probable diagnosis and reached a plan for treatment based on how sure you are of that diagnosis, you’ll need to educate the patient about the how’s and why’s of the treatment protocol. This includes educating them about any tests or procedures, treatment options, medications and steps they can take to prevent illness. Making sure you communicate the diagnosis and treatment information effectively is important so that the patient can absorb it. Educating the person about why they have symptoms and creating an understanding of why you’re treating their illness can be as important as how they are treated. Invite your patients to have a trusted friend or relative in the room who can help them to recall and process all that you say, well after the visit is over.

4. Motivating the patient to follow a prescribed plan falls right in with education. If you can get a patient to understand why it’s important to take medication or change their lifestyle – such as providing insight into what will happen if they don’t stop behaviors like smoking or drinking alcohol – then you can better motivate the person to change their behavior. Different people will respond to different types of motivation, but effectively communicating the how’s and why’s of treatment is always important

Cassimatis adds that it’s important for physicians to avoid medical jargon and to practice communication using words that most people can understand.

“For example, in the case of a heart failure patient, the physician might explain how the heart is weak and how this alters the mechanics of the brain and kidney to overwork a tired heart – and how suggested lifestyle changes and medications act to protect the heart from being overworked, giving it a chance to heal,” he says. “As physicians we need to be able to educate the patient about their condition and communicate all of the information about their treatment plan clearly and in terms the average person can understand.”

Follow-up is another crucial form of communication with patients to ensure they understand and are following the prescribed treatment.

“Today, most physicians offer their patients printed or emailed summaries of office visits with a clear explanation of treatment plan and prescribed medications. Patients also have the ability to communicate with their physicians or access test results and medical records via online patient portals. However, it’s still important for doctors or staff to follow up with patients after a visit to be sure they understand what to do and to find out if they are having any difficulties, such as trouble getting a prescription filled,” Cassimatis says. “In the end, the more communication you have between the care team and the patient, and the clearer that communication is, the better the likelihood is for a good outcome.”

Peer-to-peer Coaching; Inclusion in Med School Curricula

Rob Schreiner, M.D., president of WellStar Medical Group and executive vice president of WellStar Health System, has been a student of and a coach for clinician-patient communication (CPC) for more than 20 years. Today, he trains clinicians to be peer-to-peer coaches using direct observation.

“In 1997, I was leading continuing medical education (CME) for a large multi-specialty medical group in Atlanta when I became aware of evidence that good clinician communication led to better patient outcomes. So I decided all clinicians in the group should receive training to become better communicators with their patients,” he says. “In the course of getting certified as faculty for the communication techniques, I realized I myself had been doing it all wrong for 15 years! Talk about a humbling experience. That’s when it went from an intellectual exercise of improvement to a true passion for helping fellow physicians learn the value of effective communication with their patients.”

During the next year, Schreiner used a half-day workshop containing both didactic and experiential learning exercises to train nearly all of the physicians and advanced practice professionals (APPs) in the group how to communicate more effectively with patients.

Although there are several good curricula available to help physicians improve their communication skills, Schreiner says that he has seen more powerful change brought about through peer-to-peer direct observation followed by targeted coaching.

“The specifics of the curricula may vary, but the technique for making doctors into more effective communicators is clearly not lectures, not PowerPoint presentations, not erudite papers. In fact, the best methodology for increasing the clinician’s proficiency in communication is for them to witness a super-performer and to be witnessed by a super-performer, and then for that super-performer to provide both general and specific suggestions,” he says. “The coaching process is most effective when structured as humble inquiry, rather than ‘dictating what to do differently,’ asking questions intended to develop better self-insight into one’s communication defaults.”

Additionally, Schreiner believes that clinician-patient communication should be part of every medical school’s curriculum.

“The sentinel article on the subject was published by Vanderbilt in 1994 and only now is it becoming part of the curricula in medical school. Probably only one-fourth of postgraduate training programs [residencies] have it, and even then, only in a few specialties like internal medicine,” he says. “It took an awfully long time to include it in the medical school curricula in the U.S., and it still isn’t given an equal footing with the more technological aspects of becoming a good clinician.”

Schreiner points to a colleague’s recently published research showing evidence that empathy can be taught to medical students and residents.

“It’s a relatively new concept … that empathy can be taught just as you can teach how to quickly and expertly remove a diseased gall bladder. Some people have more aptitude for effective communication than others, but everyone can and should get better,” he says. “Good communication turns out to be as effective or more effective in the healing arts than the latest, greatest pharmaceutical.”

Four Tactics for Developing Patient Trust

According to Rob Schreiner, M.D.,  president of WellStar Medical Group and executive vice president of WellStar Health System, there are four simple tactics for establishing trust and fostering communication with patients.

“For the most part, our patients want to know (1) we care, (2) we’re competent and (3) what’s going to happen to them. But sometimes, doctors get wrapped up in the science and the data, forgetting that there’s a person in front of them who might not understand,” he says. “Here’s where I think basic good manners, common sense and caring about the human condition play an important role.”

Schreiner says doctors can practice four tactics that can establish good communication with a patient:

1. Make good initial eye contact. Smile.
2. Introduce yourself in a slow, calm way.
3. Slow down your physical and verbal cadence, regardless how busy you are.
4. And sit down! Sitting conveys that you value the patient enough to give them your time and full attention. Standing conveys, every second, that you have other things to do that are more important than caring for the patient in front of you.