This year I resolve to communicate better with my patients.
I recently read a study showing, on average, physicians interrupt their patients within 23 seconds. Additionally, another study found that during an 11-minute visit, the patient speaks for fewer than four minutes.
We must be imparting important health information if we spend that much time talking, right?
In reality, surveys identify only about 15 percent of patients fully understand what their doctors tell them and only 50 percent leave the office knowing what they are supposed to do. Is it any wonder our patients come back not having done what we asked them to do?
As a physician, I am used to telling people what I know. I studied long and worked hard to possess a strong knowledge base and I often feel obligated to share it as I try to figure out what is wrong with my patients and how to fix it.
Yet, there is another piece to the puzzle, equally important: The patient’s part of the story. As Dr. William Osler reminds us, “Listen to your patient, he is telling you the diagnosis.”
Here are five ways I plan to meet my New Year's resolution:
1. I will listen better.
My first step to meet my resolution will be remind myself that what it says on the schedule may not reflect the actual patient concern. Starting each visit with an open ended, “So what brings you in today,” while making that all-important eye contact, and listening to the story that unfolds, will be a good start.
In the hustle of cramming in patients into shorter and shorter appointment slots to save a few cents, the system has forgotten that telling a story takes time and building rapport to allow good communication does not occur instantaneously.
I will remind myself not to fear the sometimes-uncomfortable silence that can permeate an exam room while the patient finds the right word to describe the pain or tries to recollect a medication. I will refrain from adding my own words to fill the space.
2. I will explain clearly.
Once I ensure the patient has had ample opportunity to tell his or her story, I will remember not to spew out medical jargon in response as I ask questions for clarification. I will use phrases such, “If I understand you correctly, you are telling me this,” and actually wait for confirmation. The story will unfold and I will have the piece of the puzzle the patient provides. I will make a point to stop and explain why I have asked certain questions if they seem unrelated or obscure, remembering that patients do not always know the connections I have been trained to recognize.
During the exam, I will tell the patient what I am doing before I do it, explaining again parts that seem foreign or bizarre. Patients will be offered my exam findings immediately and not be forced to guess if I found an abnormality. And on the occasion that I do, I will remember that any abnormality, no matter how benign, can be frightening to a patient.
3. I will slow down.
When the findings are concerning and potentially more serious, I will take the time to slow down and permit the patient time to absorb the information before I delve into the plan or treatment. I will look patients in the eye and ask if they have questions about the findings I have described.
4. I will provide clearer directions.
Next comes the instructions, the part that patients seem to have such difficulty following. Fifty percent do not know what they are supposed to do. Have blood drawn or take a pill? When to come back and how to make that appointment? Remembering how quickly information can desert the memory, I will commit myself to write the plan down in simple steps. The name of the medication, the date of the test, even simple steps can be forgotten without a reminder. I will include the number to contact me after a specified time about results in case the lab results slips through the cracks, as sometimes they do even to the best providers.
5. I will ensure the patient understands.
Wrapping up, I will give the patient the task of retelling me the plan, reviewing the important details, and clearing up any misunderstandings that occurred. I will provide one last opportunity for questions and I will try to walk them to check out if I can, especially the ones with more complex issues and plans of care. I will tell my staff what needs to be done and what I have ordered so that they can assist the patient in following through.
Medicine is a complicated system with many moving parts. But at the end of the day, communication will create a way through the maze. My patients will be able to tell me what is wrong so that I can treat them appropriately. I will strive to lay out plans and expectations simply and concisely with frequent opportunities for clarification and questions.
It will take work, as all good things do.