Physician Patient Communication

The process of curing a patient requires an approach which involves considerations beyond treating a disease. It requires several skills in a doctor along with technical expertise. Studies have shown that good communication skills in a doctor improve patient’s overall satisfaction. There are certain basic principles of practicing good communication. Patient listening, empathy, and paying attention to the paraverbal and non-verbal components of the communication are the important ones that are frequently neglected. Proper information about the nature, course and prognosis of the disease is beneficial. Besides, patients and attendants should always be explained about the necessity and yield of expensive investigations and risks/benefits involved in invasive procedures. One should be extremely cautious while managing difficult encounters and breaking bad news. Formal training of the doctors in improving communication skills is necessary and has proven to improve overall outcome.

The importance of patient-centered care and cross-cultural communication as a means of improving health care quality across patient groups is obvious. Differences between physicians and patients, including culture, gender, race, and religion, can introduce bias into patient–physician communication. Two seminal studies have documented differences in how race and gender can affect care. For example, African American patients were substantially less likely to report equal speaking time compared with white patients.

Tips and Strategies. The basis for an effective patient provider relationship occurs through proper interview technique.  It is patient centered, based on creating the proper environment that encourages the patient to give personal high quality information.  This occurs through both verbal statements, the behavioral context within which it is said and in relation to facilitative non-verbal behaviors that create a comfortable environment and help create a partnership of care:

      1.      Accept the reality of the disorder

Many providers may have difficulty accepting functional GI or other somatic syndromes as bona fide since there is no biomarker or specific diagnostic test.    It drives behaviors such as frequently ordering of tests or communicating uncertainty.  These are patients who desperately want to be believed.  The solution here is to accept the diagnosis as real and focus on the commitment to work with the patient and his/her illness by listening communicating interest and concern and offering support.

      2.      Listen Actively

The clinical data is obtained through an active process of listening, observing and facilitating.  Questions should evolve from what the patient says.  If uncertain of the patient’s response, it helps to restate the information asking for clarification, and this reaffirms to the patient the provider’s commitment to understand.

      3.      Elicit the Patient’s Illness Schema 

To properly negotiate treatment, the provider must identify how the patient understands the illness.  In doing so a dialog can begin that will lead to a mutually specified set of goals.  For example, even with years of symptoms, patients may expect the physician to diagnose a different, structural disease and affect a cure. But the provider sees this as a chronic disorder requiring ongoing management. Thus, these differences must be reconciled in order for the patient to accept treatment and cope with the disorder.

      4.      Stay Attuned to Questioning Style and Non-Verbal Messages

Often, it’s not what you say, but how you say it that makes the difference.  In general, the physician wants to communicate nonjudgmental interest in an environment of comfort, support and security.

      5.      Offer Empathy

The physician provides empathy by demonstrating an understanding of the patient's pain and distress, while maintaining an objective and observant stance.  An empathic statement would be: "I can see how difficult it has been for you to manage with all these symptoms" or “I can see how much this has affected your life”. Providing empathy improves patient satisfaction and adherence to treatment.

      6.      Negotiate

The patient and physician must mutually agree on treatment options.  The provider should then ask about the patient's personal experience, understanding and interests in various treatments, and then provide choices that are consistent with the patient's beliefs.  Negotiation is particularly important in certain situations such as recommending an antidepressant or when referring to a psychologist for PTSD or treatment of other psychological symptoms.

Good communication skills have been considered extremely important for medical practitioners in the western world since decades. Its significance is now being acknowledged in the US and some authors have expressed the view that it is “the need of the hour” to train medical professionals in this important yet ignored aspect in clinical medicine. Follow these steps to maintain good communication with your patients.