Medicine is an art whose magic and creative ability have long been recognized as residing in the interpersonal aspects of the patient-physician relationship.
A doctor’s communication and interpersonal skills comprise their ability to gather information to aid in accurate diagnosis, appropriate counseling, giving therapeutic instructions, and establishing a caring relationship with patients. These are the prime clinical skills in the practice of medicine, with the goal of achieving the best results and patient satisfaction, which is essential for the effective delivery of healthcare.1
Introduction
Objective of doctor-patient communication
The main objective of any doctor-patient communication is to enhance the patient’s health and medical care. Studies on doctor-patient communication have shown patient dissatisfaction even when many doctors considered their communication adequate or even excellent. Doctors tend to overestimate their communication skills.1
Tongue et al. reported that 75% of the orthopedic surgeons surveyed believed that they communicated sufficiently with their patients, but only 21% of the patients reported satisfactory communication with their doctors. Patient surveys have consistently demonstrated that they want better communication with their healthcare providers.1
The principles of patient-centric medicine go back to the ancient Greek school of Cos. Yet, patient-centered medicine has not been a common clinical practice. For instance, in the 1950s and 1970s, majority of the doctors considered it inhumane and detrimental for patients to reveal bad news due to the bleak treatment prospect for cancers.1
The medical model has recently evolved from paternalism to individualism. Information exchange is the leading communication model, and the health consumer movement has led to the current model of shared decision-making and patient-centered communication.1
Benefits of effective communication
Effective doctor-patient communication is the key clinical function, and the consequent communication is the heart and art of medicine and the prime component of healthcare delivery. The three major goals of current doctor-patient communication are:1
Effective doctor-patient communication is determined by the doctor’s “bedside manner” which patients judge as a major sign of their doctors’ general competence.1
Good doctor-patient communication can help regulate patients’ emotions, aids in the comprehension of medical information, and allow for improved identification of patients’ needs, perceptions, and expectations. Patients who report good communication with their doctors are more likely to be satisfied with the treatment, and especially to share relevant information for accurate diagnosis, follow the advice and adhere to the prescribed treatment. Patients’ recovery is strongly associated with their agreement with the doctor about the course of treatment and the need for follow-up.1
A more patient-centered practice results in a better patient as well as doctor satisfaction. Satisfied patients are less likely to file formal complaints or initiate malpractice complaints. Satisfied patients are beneficial to doctors in terms of greater job satisfaction, lower work-related stress, and reduced burnout.1
Patient Satisfaction is improved by better recognition and understanding of their problems and the treatment available. This also has a positive impact on patients’ psychology, mental health, tolerance power, and quality of life.2
Components of Communication
The three basic components of effective communication are:2
Verbal components comprise the content of the message including the selection of words. The non-verbal component includes body language such as posture, gesture, facial expression, and spatial distance. Paraverbal component includes tone, pitch, pacing, and volume of the voice. While communicating, doctors mostly focus on the verbal component which constitutes only 10% of the message delivered. The non-verbal and para-verbal components contribute 90% of the total message delivered.2
The verbal content is crucial and includes information about the nature, course, and prognosis of the disease, available treatment options, nature, cost, the yield of investigations, and risks/benefits of invasive procedures. The non-verbal component of communication is frequently considered less important, the literature suggests that it significantly affects important outcomes like patient satisfaction, adherence to advice, and clinical outcome.2
Barriers to good communication
There are several barriers to good communication in doctor-patient relationships such as patients’ anxiety and fear, doctors’ burden of work, fear of litigation, fear of physical or verbal abuse, unrealistic patient expectations, lack of knowledge, and language barrier.1,2 Lack of insight due to inadequate knowledge and training in communication skills is one of the most important barriers. Finally, other factors like stress, tiredness, or lack of time majorly contribute to an overburdened setting.2
➢ Deterioration of communication skills with time
Communication skills tend to decline as medical students progress through their medical education, and over time doctors may lose their focus on holistic patient care. Additionally, the emotional and physical brutality of medical training can suppress empathy, substitute techniques and procedures for talk, and may even cause diversion of patients.1
➢ Nondisclosure of information
Serious miscommunication in doctor-patient interaction is a potential pitfall, especially regarding patients’ understanding of their prognosis, purpose of care, expectations, and involvement in treatment. These crucial factors may impact patients’ choices regarding their treatment and end-of-life care that may have a significant influence on the disease.1
➢ Avoidance behaviour
Doctors sometimes avoid discussion of the emotional and social impact of patients’ problems as it may distress them when they could not control them. Such situations can negatively affect doctors emotionally and increase patients’ distress. This avoidance behaviour may lead to patients being unwilling to disclose problems, which in turn could adversely impact their recovery.1
➢ Discouragement of collaboration
Doctors have been found to discourage patients from expressing their concerns and expectations as well as requests for more information. This negative effect of the doctor’s behaviour and the resultant nature of the doctor-patient communication discouraged patients from asserting their need for information and explanations.1
➢ Resistance by patients
Nowadays patients are no longer passive recipients and can resist the power that society offers doctors. They can totally resist the monologue of information provided by actively reconstructing expert information to assert their perspectives, knowledge, experiences, and social realities of their lives.1
Strategies for improvement
➢ Communication skills2
o Patient listening
✓ Make the patient and attendant comfortable.
✓ Do not have discussions while walking in the corridors.
✓ Show interest when the patient is talking with your mannerism, body language, and active involvement.
✓ Mannerism like nodding may help in convincing the patient that you care and have understood their problem.
✓ Do not interrupt them.
✓ Always ask if they would like to add something before concluding.
o Before the formal medical interview with the patient
✓ Maintain confidentiality and privacy. Do not consult your patient in presence of other people.
✓ Greet the patient and introduce yourself.
✓ Know your patient’s name.
✓ Establish eye contact with your patients.
✓ Make the patient comfortable with a general non-medical inquiry.
o Conducting a medical interview with the patient
✓ Observe both verbal and non-verbal clues from the patient.
✓ Provide prompt responses to patients’ queries.
✓ Discuss the nature, course, and prognosis of the disease, treatment options available, and requirements of the investigations.
✓ Involve the patient in the decision-making process.
✓ Motivate your patients regarding adherence to lifestyle modifications.
✓ Explain in simple language.
o Communicating with support staff and colleagues
✓ Always be formal.
✓ Appreciate their hard work.
✓ Never talk low about other colleagues and junior associates
✓ Seek a second opinion proactively.
✓ Explain the importance of consent forms to paramedical staff or junior associates.
✓ Set examples for supporting staff.
✓ Audit and regular feedback enhance professional practice. Always give appreciation and positive criticism.
➢ Collaborative communication1
Collaborative communication is a 2-way exchange of information. Doctors should collaborate with their patients to deliver the best care and refrain from making decisions based on quick assessments. Doctors must take time or set up opportunities to offer and discuss treatment choices and share the responsibility and control with the patients.
➢ Managing difficult encounters
o Conflict management1
Recognize the feeling of helplessness, frustration, confusion, anger, uncertainty, failure, or sadness in patients. Try and understand the perspective from both sides and develop skills to identify problematic responses in patients or themselves to de-escalate the situation and allow the problems to be turned into clinical success.
o Health Beliefs1
Understand the patient’s social context, expectations, and experiences. Identify and address perceived barriers and benefits of treatment to enhance patient adherence and ensure that the benefits and importance of the treatment are understood.
o Demanding Patients2
Avoid a judgemental approach and do not show anger. Ensure the best medical care for the patient.
o Dependant Patients2
Maintain professional behaviour with a well-established boundary. Involving the patient in decision-making can be helpful. Assure them full attention in the subsequent visits.
o Manipulative Patients2
Be empathetic and listen to their problems attentively. Reformulate the treatment plan with the patient after setting limitations over expectations.
o Self-destructive Patients2
Set realistic expectations and try to understand the reasons for non-adherence and offer or arrange for psychological support. Be non-judgmental, and compassionate and listen to them. Prioritize the patient’s immediate concerns and expectations.
➢ Breaking bad news2
Many doctors lack competence and confidence in their ability to reveal bad news. A strategic approach according to the patient’s own knowledge & expectations can be useful in such situations. This can also condense the emotional turmoil into an effective future management plan in the same setting.
Conclusion
Good communication skill among doctors is essential in building a trustworthy doctor-patient relationship that not only helps in therapeutic success but also results in job satisfaction among the doctors. Not many doctors are naturally blessed with good communication skills and formal training in this can be of great benefit.2
References:
1. Ha JF, Longnecker N. Doctor-patient communication: a review. Ochsner J. 2010 Spring;10(1):38-43. PMID: 21603354; PMCID: PMC3096184.
2. Ranjan P, Kumari A, Chakrawarty A. How can Doctors Improve their Communication Skills? J Clin Diagn Res. 2015 Mar;9(3):JE01-4. doi: 10.7860/JCDR/2015/12072.5712. Epub 2015 Mar 1. PMID: 25954636; PMCID: PMC4413084.
