Our curricula are vast in the breadth of education on medicine. We begin with anatomy and physiology before moving to pathophysiology and specific diseases. We parlay this knowledge into treating a variety of conditions and continue to learn how to differentiate normal findings every day in practice. However, there is one area that is often left essentially untouched: communication. There is far less emphasis on how to communicate with patients and families, but it is a skill critical for a successful practice.
Effective communication is key to both reassuring the patient in good health and educating the patient with an acute or chronic disease. Communication, defined as the giving and receiving of information, is affected by many factors. These factors include those over which you have no control (patient-specific) and those that you can use to the advantage of you and your patient (clinician-specific).
Patient-specific factors that affect communication include health literacy, education, attitudes and beliefs, current state of mind, and current state of dress. Further, patients may make assumptions about their health based on prior experience, internet searches, myths, prior education by health care providers, and even family members. The patient may put substantial value on these sources, so it can be difficult to dispel preconceived notions. If you do not identify and rectify inaccurate beliefs, your treatment may fail, even if it is absolutely appropriate.
Clinician-specific factors may also affect communication. These can include the amount of time allotted to a visit, confidence, body language, language complexity, perception of empathy, reflective listening, and establishing realistic expectations. For example, lack of time is an ongoing problem. If a visit cannot be extended, consider bringing the patient back at a shorter interval or enlist other staff members to finish the education. Tied to this is keeping education at a level that the patient can understand. Patients often do better when information is given in smaller, more digestible bites. Avoid medical jargon and consider using examples/analogies familiar to the patient to facilitate understanding of complex medical situations.
Projecting confidence is common issue for newer clinicians, but it can also happen to veterans with an unclear diagnosis. It helps to explain to the patient why the diagnosis or treatment path is unclear and what you plan to do to clarify. Then your patient can be confident that your uncertainty is not based on lack of knowledge. Body language can project a message as well. Being seated at the same level as the patient can be reassuring and leave an impression that more time was spent connecting.
Empathy, especially as perceived by the patient, is vital. You do not have to experience a disease to understand the impact of the symptoms or treatments on the patient’s quality of life. There is much research on how burnout affects clinician empathy and how lack of empathy affects patient confidence and subsequent therapy adherence. If you are at risk for or experiencing burnout, get help. This situation puts you and your patients at risk.
Empathy can also be expressed through reflective listening to truly understand a patient’s words. Ask the same question in multiple ways to be sure you comprehend the patient’s language. For example, a patient may deny picking at a spot, but if you ask if they touch it or remove scale regularly, they may readily admit it. In this case, a patient may not consider their action as picking or they may not be willing to admit to what they see as a negative activity. Determining the patient’s expectations of a diagnosis or treatment can clarify and set realistic expectations and reduce follow-up questions. Patient education can also be enhanced by additional materials such as brochures or patient handouts.
Demonstrating genuine empathy is critical, but touch can be a powerful communication tool, particularly in dermatology. Touch can indicate to the patient that they are important and worthy. A warm handshake or touch on the shoulder can communicate that they have been “seen,” and feeling a lesion or rash can give you information about the possible diagnosis.
An honest, self-reflective analysis can foster effective communication. Identify your strengths and weaknesses, and review your methods to gauge patient comprehension. Evaluate your educational tools based on patient adherence to therapy and “call-backs” to your staff. Incorporate this information into your practice and make improvements where needed. Every person on the health care team benefits when communication is effective, especially the patient.
Ms Winter is chair of the SDPA Public Education Committee.
