When I was a new D.C., a 62-year-old patient came into my office with complaints of mid back pain. After examining him, I adjusted his mid-thoracic spine and immediately heard a pop, followed by a scream.
Posted in Patient Interactions on Wednesday, November 09, 2016
He said he felt a sharp pain in his right side. I took an X-ray and found an aligned hairline fracture on the lateral aspect of the seventh rib. I apologized and explained the rib was fractured. I also told him I would help him, but the rib would heal itself in six to eight weeks. The patient silently listened and left my office without comment.
Many emotions ran through me as I anxiously worried about the letter I expected would be coming from his attorney. This led me to wonder: Why do some doctors get sued and others do not?
Over the years, I’ve learned the answer to this question is really quite simple. Those who don’t get sued generally have a good rapport with their patients. Conversely, it’s potentially a catastrophic mistake for a doctor to underestimate the importance of communication skills because they’re not “scientific.”
Research backs this up. When patients genuinely like their doctors, the results are increased cooperation with the treatment plan, more patient referrals and logically fewer lawsuits.1 Patients who believe their physicians are doing their best are less likely to sue in case of an unexpected outcome.2
Why is this? Let’s look at the relationship from the patient’s point of view. Most patients don’t judge their doctors by credentials or clinical expertise—four out of five don’t even know if their doctor is licensed.3
What patients do consider important is their satisfaction with the communication provided by the doctor. Communication was the reason 52 percent of patients were satisfied with their physicians compared with about 25 percent who touted quality of care for their satisfaction, according to a 2000 VHA study.
The good news is the traits patients attributed to good doctor communicators are completely controllable and easy to implement into a professional practice. Here are four simple ways effective doctors communicate to improve patient satisfaction and reduce practice risks.
1. Promote Interactive, Two-Way Communication
- Use facilitative statements and questions such as, “Is there anything else you think I should know?” or “Tell me what you think about this treatment plan.” This type of questioning offers you an excellent opportunity to find out what is really going on in the patients’ minds and lives.
- Don’t deliver monologues. Instead, focus on what patients are saying and show them you have no other concern than what is in their best interest.
- Ask nonclinical questions like, “How is this problem affecting your personal, professional or family life?” and “What changes to your life has this problem caused?” This helps patients feel their thoughts and concerns matter.
- Use common words and terms, rather than healthcare jargon. Patients want to better understand their condition and treatment. Clear visual aids and quality written material also help with patient comprehension.
2. Be a Good Listener
- Invite patients to express themselves, actively participate and take ownership of their healthcare. Ask them questions such as, “What are your thoughts about the problem?” or “Are you comfortable with the therapy proposal?”
- Use a soothing tone of voice when patients’ anxiety and emotions spill out. You’ll be seen as more warm and caring because many doctors do not deal well with the emotional side of patient behavior. Basically, if a doctor’s tone is less dominant and more concerned, there is less chance of a lawsuit.4
- Listen to patients vent their emotions or frustrations without saying a word. This step alone can be very therapeutic.
- Don’t let anger, irritation or impatience creep into the conversation. No matter how many times a patient asks the same question, speak as if you’re talking with a loved one.
3. Use Nonverbal Cues
- Convey warmth through a smile and handshake. It’s a simple step that goes a long way toward making the patient feel valued.
- Change your facial expression, nod, paraphrase patients’ statements or use interjections such as “aha”
or “I see” to indicate you’re paying attention. The patient won’t give you credit for understanding their problem until you acknowledge it somehow.
- Demonstrate good humor even when you’re having a bad day.
- Maintain comfortable eye contact, sitting and leaning slightly toward the patient. (Don’t stand with your arms crossed or hold the doorknob, which conveys impatience.)
4. Spend More Time with Patients
- Explain to every patient what will happen during each visit. Tell each patient, “I’ll leave time at the end for your questions.” Encourage conversation by asking patients to “go on” or “tell me more.” Doctors who are viewed as good communicators spend 20 percent more time examining their patients.5
- Acknowledge and introduce yourself to the patient’s family and, with the patient’s permission, invite them into discussions.
- Talk about their jobs, families or hobbies to show patients you see them as people rather than as collection of complaints.
Incorporating techniques like these into your practice can help you maintain optimal patient relationships, ultimately resulting in improved patient care and a reduced likelihood of a malpractice allegation.
By the way, I never got the letter from the lawyer. The reason? I think it was because the patient liked me.
1 Shiel, Robert C. Physician-Patient Interactions Advances in Chiropractic, Vol.2, 1995
2 JAMA Good Communication Practices Can Minimize Malpractice Risks, Feburary 19, 1997
3 Sportelli, Louis. Homecoming, National University of Health Sciences June 24, 2005
4 Rogers, Bill. Law, September 1997
5 Goldman, Jane. Preventing Malpractice. Hippocrates 11(10), 1997