By Graham T. Watson, MD
For many years, the role of a physician was to memorize large amounts of information to diagnose and treat patients effectively. But we live in the information age, and while developing a comprehensive understanding of your field still takes brain power, the best physicians are often those with superior interpersonal skills.
Further, a patient in the 1960s may have been satisfied with a “take two pills and call me in the morning” approach. Nowadays, patients yearn to understand their bodies and their diseases. This paradigm shift demands that physicians (and APPs, given the meteoric rise of mid-level providers in patient care roles) step up to the challenge.
And while effective provider-patient communication is widely known to boost patient satisfaction scores and reduce malpractice lawsuits, its impact goes far deeper. A robust body of research now demonstrates that high-quality communication can majorly impact specific health outcomes.
Some impacts are predictable, such as treatment compliance. Just one example: a 2021 study of 2,571 Black patients with hypertension, published in the Journal of the American Heart Association, found the odds of medication adherence was 38 percent greater in patients who reported high levels of conversation with their clinicians.
But using proven communication techniques such as “shared decision making” can impact objective outcomes, including overall survival in some circumstances.
Conversations that promote shared decision making by providers and patients can go beyond simply understanding how and when to take a medication. When patients feel they are a part of their own care, it empowers them. Patients report feeling more optimistic about their illness and more motivated to take action to improve their health, and they are better at communicating their symptoms to providers.
An important note: Communication skills are essential for all providers, including surgeons who spend much of their time in the operating room. Even brief, positive face-to-face interactions matter to patients.
Here are a few thoughts on improving communication:
• Plan ahead. Before entering an exam room, reflect on the information and treatment options – with benefits and risks – a patient needs to hear and discuss. An ideal care plan is both effective and in line with each patient’s values and goals.
• Sit down and make eye contact. One study showed that patients estimate physician interaction to be 22 percent longer if a provider sits versus standing for the same amount of time. Stay off the computer (I’m a proponent of medical scribes to accomplish this). Look for non-verbal clues such as mood and energy level.
• Avoid jargon. Even one big word can be very disruptive because patients tend to get hung up on it and miss sentences that follow.
• Write down information. Keep a notepad in exam rooms. In my practice, I often write the diagnosis, stage of cancer, treatment basics and prognosis. Patients can take that piece of paper home and digest it when less overwhelmed.
• Be ready to repeat information. Don’t assume patients will remember what was said in a previous appointment. Be patient.
• Use the “teach-back” method. Ask patients to repeat what was just discussed about a treatment plan or follow-up step to know if communication succeeded – or failed.
• Tackle risk assessment from multiple angles. For example, if a drug has a “20 percent” chance of a certain side effect, that’s mathematically identical to a “one in five” chance. Yet different patients might hear one as better – or scarier – so consider saying both.
• Help patients take ownership of their health. Pre-diabetic patients, say, might prefer trying an exercise plan or seeing a nutritionist before turning to medication. If they’re simply handed a prescription, compliance is less likely.
• Seek out articles and continuing education opportunities about communication skills. Consider keeping up with this so-called “soft science” as important as reading about emerging medications and surgical techniques.
After all, our responsibility as providers is not only to be knowledgeable but to be able to impart that knowledge to our patients.
Dr. Watson is a Medical Oncologist and Hematologist with Virginia Oncology Associates, based at the Brock Cancer Center in Norfolk. virginiacancer.com
