Four Critical Communication Skills in the Medical Home Model

As the Patient-Centered Medical Home (PCMH) model gains traction across the country, more and more practices are embracing a team-based approach to patient care with the goal of improving patient satisfaction, care quality, and reducing care costs.

Improved communication between staff, physicians, and patients is critical to helping practices meet these objectives, said Sandra Reifsteck, RN, director of the Office of Development and Quality Outcomes at the Institute for Healthcare Communication, an organization dedicated to advancing healthcare quality by improving healthcare communication.

There is "evidence-based research" that communication can improve key areas that directly align with PCMH goals, Reifsteck said during her October 22 presentation at MGMA12 in San Antonio. Those goals include a focus on the "whole-person orientation," coordinated and/or integrated care, enhanced access to care, and improved quality and safety
as the "No. 1" objectives.

That’s because communicating well allows physicians to make better diagnoses, it leads to improved patient adherence, it raises patient satisfaction and safety, and it helps foster a teamwork mentality, she said.

Here are four of Reifsteck’s key recommendations for improving communication at your practice:

Engage. Physicians and staff should keep in mind that the first two minutes of the patient visit are critical, she said, noting that physicians need to focus on connecting with the patient, building trust, and soliciting the patient’s concerns at this time.

One way is by asking open-ended questions. "You really want to be able to let [patients] tell you exactly what’s going on," Reifsteck said.

Physicians should also repeat to the patient what the patient has expressed. "Don’t parrot, but state back in their words the content of the patient’s message," she said.

Educate. Physicians and staff must communicate in a way that is easily understandable to patients, said Reifsteck. But once they have communicated a key point, it’s critical that physicians and staff gauge whether the patient understood the exchange.

"Always ask what the patient already knows, customize your message to their level of understanding, ask the patient to repeat the key elements," said Reifsteck, noting one study finding that 50 percent of patients leave the appointment with no idea how to move forward, and 25 percent of those patients have an incorrect understanding.

Enlist. Patients must use communication to engage in shared decision-making with patients, said Reifsteck. "... If we don’t get them on board doing what needs to be done, they’re going back and forth to us all the time."

In medical homes especially, this partnership approach should extend beyond the physician-patient relationship to the wider healthcare team.  

Empathize. "Empathy is the single most important skill in building relationships with patients and staff," said Reifsteck, noting that it’s often underutilized. She cited one study finding that empathy is expressed in only 21 percent of primary-care visits.

Here are some practical examples for how physicians can better incorporate empathy into patient visits:

• When the patient expresses an emotion such as, "I’m worried," the physician should respond with something like, "I can see that you’re worried ..."

• When the patient shares a challenge such as, "I’m missing a lot of work because of 'X,'" the physician should respond with something like, "I bet you’re worried about missing a lot of work."

Normalizing the patient’s emotions by saying something like, "Anyone would feel scared in this situation"; self-disclosing to the patients by saying something like, "My sister went through this"; and partnering with the patient by saying something like, "We can handle this," are some of Reifsteck’s other suggestions.

"Empathy is just sort of getting in their [patients] shoes and understanding what they’re going through," she said.