In medical school, physicians probably learned communication skills such as interviewing (getting information from patients on the reasons for their visit), processing (assessing the patients and their disease), and talking (clearly relaying diagnoses to them).  But other important aspects of patient care, such as empathy, relationship-building, and dealing with patients’ emotions are often given less emphasis.

“There are some very simple things you can do to allow a patient to feel they have your attention,” said Walter Baile, MD, director of the Interpersonal Communication and Relationship Enhancement (I*CARE) program at MD Anderson Cancer Center in Houston. “Sit down, make eye contact, and don’t interrupt until they are finished talking. Doctors don’t always get sued because they make mistakes; it’s often because they disregard patients.”

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Relationships matter

One of the most overlooked functions of communication, according to Dr Baile, is establishing that patient relationship. “This is a crucial concept,” he said. “What can we do as clinicians to establish a trusting relationship with patients so they feel we have their best interests at heart and care about them as people, and not just bodies?”

Patients want to be treated like individuals, not guinea pigs. Physicians should explain the actions they take, such as prescribing medication or ordering tests, and inform patients about the possible consequences, he said.

Although physicians may find it daunting to establish connections with patients during short visits, it does not take long to obtain information from patients—such as what they do for a living—that could provide the basis for a closer physician-patient relationship.

A simple phrase like “Tell me about yourself and who is in your family,” is a good way to start a visit, Dr Baile said. This demonstrates that physicians have an interest in them as people and not just patients. He noted also that people from around the world seek care at MD Anderson, and physicians may need to know important things that affect their care such as that they may not be able to afford to stay nearby for a long period for radiation treatment or other treatments.

Employ ‘NURS’

Jane Schell, MD, a palliative care nephrologist and clinician educator at the University of Pittsburgh Medical Center, said physicians often go wrong by heaping information on patients so they understand the care they are receiving. Physicians should avoid medical jargon and give patients big-picture information.

Dr Schell recommends back-and-forth communication between physicians and patients—an “ask-tell-ask” approach. The objective is to learn what patients know about their condition, the barriers they may face, what, if anything, they want to do about it, and what they want to know about their condition.

An ask-tell-ask approach can help improve communication by encouraging physicians not to lead patient encounters with their agenda, but rather to take into account what patients want out of a visit. It also can get physicians out of the habit of interrupting patients.

Physicians should expect that patients may react emotionally to information given to them, and they may cry or exhibit anger. Using the NURS tactic—name, understand, respect, and support—can help. When patients get emotional after hearing bad new physicians could start with a phrase like, “I can see this information really shocked you.” That, Dr Baile said, is more powerful than saying, “Don’t worry, we have a cure,” or “Survival rates for this condition are good.” Support for the patient may include praising them for their endurance such as  “ you really toughed it out through this harsh treatment”.

Along with asking patients what they understand about their condition, Dr Baile recommends asking patients what worries them most. One might be surprised that while many patients may be afraid of dying from their disease, others may be worrying how to get a ride to the next doctor visit .

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