General Communication Tips
In The Resilient Physician by Wayne and Mary Sotile, several guidelines to effective communication in any context are suggested:
1. Be assertive. Passivity in communication can be a barrier, as can being aggressive. Assertive communication requires clear and direct requests, being positive, and being respectful. Consider using “and” in statements, rather than “but.” Research indicates that when people hear the “but” in a statement, they will tune out any positives that precede it.
2. Be warm. Highlight positives frequently. Give honest compliments whenever possible. Pay close attention to your body language. Is your face relaxed? Do you smile? How is your eye contact? Are you an engaged listener? How is your tone of voice?
3. Show empathy. The key is listening actively and tuning into the other person’s experience. Remember that over ninety percent of the message comes from nonverbal cues. They suggest the following:
- Clear your mind of distractions.
- Focus on the speaker. Don’t interrupt.
- Look for nonverbal communication cues.
- As you are listening, ask what the person truly wants you to hear.
- Summarize to them what you think they are saying, without judgmental statements.
- Watch for how they respond to your responses. Are you making them feel relieved and cared for?
- Clarify, if they feel you don’t understand.
- Discuss what can be done to resolve the situation.
- Validate what the other person feels, even if you disagree.
A quick mnemonic that can be considered (as referenced by Sotile and Sotile from The Patient’s Story, by Smith and Engel) is NURS
- Name the emotion
- Show you Understand
- Show Respect
- Support in a partnership approach
4. Listen. Spend as much time listening as you do talking. Some people like the LADDER mnemonic:
- Look at the other person
- Ask questions
- Don’t interrupt
- Don’t change the subject (without permission)
- Curb your emotions
- Respond – reflect what they say, validate it, offer support, keep a partnership approach, be respectful, and don’t over- or under-react to what the speaker says.
5. Be specific. Specify where you are, and make sure your nonverbal behaviors are congruent. Be explicit about how to act on the conversation, or follow up on something.
6. Self-disclose with discretion. Share some when it is relevant, but don’t shift the focus of the conversation.
7. Use humor appropriately.
8. Select positive words. Avoid “don’t, won’t, didn’t” and “You better…”
9. Match the pace of the person to whom you are speaking. You can then modify the pace to where you would like it to be.
10. Check your hearing (literally).
Tips for Talking to Patients
Here are a few tips from The Resilient Physician that tie into specifics of what to do in patient interactions:
- Apologize if you kept them waiting
- Acknowledge them prior to the exam
- Use their name
- Demonstrate a knowledge of their personal or family history
- Tell them what you will do during the exam before you do it
- Sit, if you can
- Touch their arm or shoulder while examining.
- Ask open-ended questions sometimes.
- Make appropriate eye contact
- Inquire about the range of their concerns
- Apologize for and explain interruptions
- Involve the patient in planning treatment
Here are a few other general suggestions:
- Focus on why they are really at the visit. Where do you sense they want to focus?
- Don’t avoid/exclude the emotional, social, spiritual, and other potential influences on how they communicate.
- Don’t hesitate to ask, “How can I help you?”
- If you don’t know, just say so. You can always tell them that you will do some checking and get back to them.
- Take time to tune in to your own needs and emotions. How might they influence your communication at the moment?
http://www.aachonline.org/ – American Academy for Communication in Healthcare – has extensive links and other resources, including a free trial of doc.com (see below)
http://webcampus.drexelmed.edu/doccom/user/ – Doc.com contains a number of online communications skills modules, including a free demonstration
http://familymed.musc.edu/ – American Balint Society. Resources on conducting Balint groups, support groups that focus on the challenges that arise for healthcare practitioners
http://www.healthcarecomm.org/ – Institute for Healthcare Communication – offers communication training courses
http://www.mindtools.com/page8.html – General guidelines from Mindtools.com site about how to improve communication in the workplace
http://www.wikihow.com/Communicate-with-Body-Language – Wikihow article on how to communicate more effectively using body language
http://www.acponline.org/clinical_information/journals_publications/acp_… – guidelines from ACP on communicating bad news
http://www.feinberg.northwestern.edu/ccm/ – Northwestern University Center for Communication in Medicine Website. Includes abstracts of their research findings
Seaman, B. Charting the doctor-patient relationship – nice general overview of physician-patient communication and what some of the research shows
Travaline, et al. Patient-Physician Communication: The Why and the How – helpful review of the research and good suggestions surrounding how to overcome specific communication barriers
Dugdale, et al. Time and the Patient Physician Relationship – observations surrounding how health providers can best spend their time
Lee SJ – Enhancing Physician-Patient Communication – from the journal Hematology, focuses in great detail on breaking bad news, working with people feeling intense emotions (anger, anxiety, depression), shared decision making, and understanding patient perspectives
Zoppi and Epstein, Is Communication a Skill? Communication Behaviors and Being in Relation
Archives of articles on communication from the Journal of the American Medical Association
McGill University Library – nice array of links and full-text articles centering on physician-patient communication.
Steward M. Effective physician-patient communication and health outcomes: A review. Can Med Assoc J. 1995;152:1423-32.
http://www.sciencedaily.com/releases/2007/04/070409144754.htm – Science News article summarizing study findings relating physician communication to health
http://www.aafp.org/fpm/990500fm/23.html – aafp article on ways to improve communication. Has a number of useful tips
Books by the American Medical Association
Berent IM, Evans RL. The Right Words: The 350 Best Things to Say to Get Along with People. NY: Warner (1992)