We have more ways to connect with each other these days than ever before—text, video chat, even old-school email and phone—but it can sometimes feel as though we’re not really getting through. We may be able to zap information back and forth at dizzying speed, but how well are we really hearing each other?
Communication in our world has changed significantly,” says R.A. Muggia, MD. “Many people aren’t even used to communicating face to face.” Dr. Muggia, a member of New England Quality Care Alliance (Tufts Medical Center’s affiliated physician network), and Chief of Gastroenterology at Winchester Hospital, has looked closely at physician-patient communication. He says the problem is exacerbated in the doctor’s office, because physicians feel rushed by demands for their time and burdened by administrative requirements. Patients, meanwhile, are often intimidated by fear of the unknown, unfamiliar surroundings and technical terminology. So what can both doctors and patients do to facilitate the kind of communication that leads to excellent results? We asked some top doctors.
How do you get patients to open up? We asked Martin S. Maron, MD, Director of the Hypertrophic Cardiomyopathy (HCM) Center. The only way patients completely engage in finding the right treatment course is to become empowered to make good decisions. That means that our primary goal is to provide information, as clearly and succinctly as possible, so patients without any medical background can understand what the optimal treatment options are for them. That’s where the art of this process lies—to sit patients down and draw out the specific information you need, and communicate the information to them that they need. We treat patients with HCM, a complex heart disease with a number of important lifestyle implications. The patients often arrive confused and anxious—for good reasons given the enormous misunderstanding surrounding the diagnosis. So we try to create a clinic visit environment that’s different, scheduling appointments with sufficient time to give patients and family members time to relax and get in the right frame of mind to absorb as much information as possible. Our goal for each patient is to take something really complex and break it down into smaller pieces of information that can be easily processed. If we accomplish this, we earn enormous trust and respect from the patients, which establishes a healthy long-term relationship and the best outcome possible for the patients. To reach Dr. Maron and the Hypertrophic Cardiomyopathy Center at Tufts MC, call 617-636-8066.
In his own words, R.A. Muggia, MD, Chief of Gastroenterology at Winchester Hospital, explains how coaching can help doctors keep patient care front and center. There are many patients walking out of doctors’ offices wondering, “What just happened?” That’s because patient communication skills are not good enough, and physician communication skills are not good enough. That’s a big problem, because the communication process is integral to an effective treatment process.
Good communication can be a challenge for doctors when quality measurements and business metrics intrude on patient-focused care. The danger is that the patient doesn’t feel acknowledged as a person. I was once at a charity event and this guy walked up to me. “I know why you look so familiar to me,” he said. “You did my colonoscopy, and you were amazing! Right before I left, you came out, and you shook my hand, and you asked me if I had any questions.” So it wasn’t our fancy HD monitors that made him think we were amazing. It wasn’t the personal and dedicated care from the nurses. And it wasn’t even the chocolate chip cookies and coffee. It was that I came out and shook his hand. Why could that be? Because colonoscopy is really scary for a lot of patients who have never had surgery before, and they pay attention to everything, including whether the doctor seemed engaged in their outcome.
Doctors aren’t used to receiving feedback, and in my experience they’re not receptive enough to coaching. That has to change. When I give talks on this issue, just about the only pushback I get is: “I’m insulted that you think I need more training. I’m already a good doctor.” The other one I hear is: “You know what? Patients only care that I’m doing the right thing for them.” You may be a very good doctor. That doesn’t mean we all can’t benefit from reflecting on how improved doctor-patient interactions can better engage patients in their own healthcare. All of us can become even better. For more information on physician coaching, contact Dr. Muggia at firstname.lastname@example.org.
What can doctors and patients do to improve communication? James Yoo, MD, Chief of Colon and Rectal Surgery at Tufts Medical Center, offers a few pointers.
▶ Prepare for the appointment. It comes down to time, and we don’t have a lot of it. If you can spend some time familiarizing yourself with a patient’s medical records before the appointment, it’s a real advantage. That gives you more time to talk with the patient once you’re in the room.
▶ Concentrate on the patient. I try never to do electronic note-taking when I’m with a patient. With electronic medical records, you spend a lot of time either reading the records or writing them, which takes your attention away from the patient. When I’m with a patient, I jot notes down on paper, which just feels less intrusive. You really want to spend time with the patients and get them to engage with you and trust you.
▶ Include the patient. When you must look at something on the screen—a CT scan, for instance—invite the patient to look with you.
▶ Prepare for the appointment. You may feel emotional at your appointment, and you’re going to have a lot of information thrown your way. Try to write down questions ahead of time so you’re not scrambling to think of them at a difficult time.
▶ Do your own research. Consult trusted Internet resources such as WebMD to research your problem. (I would steer clear of some patient chatrooms as the information may be unreliable.) Knowing about your medical issue before the appointment can help you ask better questions and communicate your concerns more effectively.
▶ Bring someone to the appointment. with you Let’s say we’re talking about cancer; it’s really overwhelming: what the surgery’s going to involve, [there’s] a lot of information. So having another pair of ears, and someone to discuss things with later, is invaluable. To connect with Dr. Yoo and the Division of Colon and Rectal Surgery, call 617-636-6190.
It’s not enough to merely want to connect with patients. Eloise Chapman-Davis, MD, a gynecologic oncologist, tells us how she makes it happen.
Q. Everyone agrees that doctor-patient communication is crucial, but it takes work. How do you open a good dialog with a patient?
A. I start with the attitude that it’s a privilege for me to be welcomed into their personal space. It helps them feel less intimidated and more comfortable with the idea that I’m here to help them in their time of need.
Q. Once you’ve established a welcoming mood, what’s next?
A. It starts even before they arrive at my office. I tell them to bring whoever then can—friends, or family; Someone who will be a second set of ears. By the time I walk in, their friends or family are in the room and they are already feeling more at ease.
Q. So it’s not just the patient who has to be made to feel comfortable.
A. That’s’ right. I tell everyone present that we will all sit down face to face. At that point, they will be able to ask every question they want and they’ll hear everything that I say to the patient. Whatever the outcome, everyone will feel like they know what’s going on and a sense of trust has been developed with all involved.
Q. Good conversation seems to be about creating the environment for it.
A. Everyone needs time to feel comfortable with me, with the diagnosis, and with the treatment plan. After that, the patient and her supporters can hopefully get beyond the anxiety and begin to really tell me what I need to know, and really listen to what I have to explain. It all starts with making the patient feel respected and cared for.
Q. As a cancer specialist, you have to explain technical medical details to people who are not medical experts.
A. These days most people use the Internet to do basic research, so patients are more informed than ever. But I still use handouts and visual cues in the office, with information, diagrams and photos for every type of cancer. That invites patients into the treatment process.
Q. What happens when you do all of this and there still seems to be a communication problem?
A. That can happen. Sometimes I just sense that someone doesn’t feel like they can articulate their problem. So I’ll try to reach out to a primary care physician or a family member with the patient’s permission first, to see if I can get more details from them. You’d be surprised how often you can learn about the underlying issues if you just talk to someone who knows the patient well. To reach Dr. Chapman- Davis, call 617-636-6058.