Medicine is stressful. Every aspect of interpersonal relationships, communications, business, finance, operations, and customer service that one would see in any other field are present in medicine. However, layered on top of all that is the simple fact that medicine’s product is healthy human life, and everything gets even more intense. Leaving med school to start a residency, and then finishing residency to take on an attending position, are stressful and intimidating transitions for any young MD. We can’t speak to the challenges of providing actual care, but we did want to give those new physicians reading here our thoughts on communication-related ways to smooth out the process.
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We talked about this in a recent blog post, and will be continuing to cover the subject in the near future. The short version is, well, exactly what we said in the section title. All those buzzwords like honesty, authenticity and transparency do actually make a difference in deflecting the chances of a malpractice suit after a mistake. Apologies are well-received by patients and families. Even better is to set expectations with clear communication up front so that no one is caught off guard when, say, a rare but known potential complication occurs.
A 2001 study in Family Medicine found that patients in primary care settings get an average of 12 seconds to speak before interruption from the resident. An 1984 study that is frequently cited in discussions around patient-provider communications found that less than 1/4 patients were given the chance to compete their “opening statement.” Additionally, in more than 2/3 of cases, physician interruptions led to questions about a “specific concern,” meaning that patients didn’t have a chance to give the full context of their situation. We know, you’re swamped. You would rather be spending time with patients than dealing with all the paperwork necessary to maintain compliance. And it’s that regulatory landscape that reduces the time you can spend with patients, creating a cascade where one of the end results is compressed conversations that leave no one satisfied. Even so, if at all possible give the people in your office a chance to finish describing the situation. They will feel heard, potentially leading to a better relationship overall. Additionally, they may drop a comment tangential to that specific concern that turns out to have significant bearing on their situation. You may have an easier time treating them as a result.
Human nature is such that we all overestimate ourselves. The overconfidence effect or illusory superiority is well-documented in everything from driving to teaching ability. None of us are immune, so it’s no surprise that this problem of self-perception manifests in the doctor-patient relationship. In 2005, a trio of orthopedic surgeons published an article that references a 1998 survey from the American Academy of Orthopedic Surgeons (link not available): “According to this survey, 75% of the orthopaedic surgeons believed that they communicated satisfactorily with their patients, but only 21% of the orthopaedic patients reported satisfactory communication with their physicians. This gap was most evident in categories such as listening and caring and time spent with the patient.” It may be worth stepping back and reviewing your communication style, or having someone sit in on a few patient appointments to give some feedback. It’s likely that we’ll all always overestimate ourselves (and the patients are doing the same thing at the same time), but at least we can take steps to close the gap and make sure our message is a bit clearer.
There are countless blog posts out there giving patients advice on how to talk to you. Yeah, it’s the internet, and there’s probably plenty of pablum. Still, your patients are reading it, so you should be familiar with how they’re thinking about approaching you. If you understand how they’re being advised to advocate for themselves or ask questions, you’ll be more prepared to respond effectively.
Patients of physicians who received training in communications were 62% more likely to follow their advice than were patients of untrained providers. Looking at the statistics a different way, the same study found that, “Patients of physicians who communicate well have 19% higher adherence, and training physicians in communication skills improves patient adherence by 12%.” Once again, we’re suggesting doing something that will take time you probably don’t have. We know it’s easier said than done. If you can, though, find ways to brush up on your speaking and communication toolkits (those are related but distinct skill sets). Sometimes, just practicing explaining a complex medical concept to Great Aunt Helga during Thanksgiving dinner can make a difference, so take opportunities wherever you can squeeze them in.
There’s been so much written on this subject in the last few years that we’re going to keep it very brief. We humans don’t multitask, we task switch. When we do everything, nothing is done well. You, your patients and your team will benefit from minimizing the pressure to do it all, right now.
Especially when it comes to critical situations. Research in an ICU setting has shown that “intrateam discordance” leads to “distress” among team members. Different providers respond differently to the same situation, which can split a care team and cause communication breakdowns. Once again, clarity on the front end may help minimize these problems; for example, transparency about why an intervention is being pursued. All the usual team-building rules about trust and collaboration apply here.
Lastly, go get some sleep. We stated the obvious at the beginning of this post: healthcare is stressful. Another study, this one published last year in Critical Care, showed how emotional exhaustion among providers leads over time to breakdown of team dynamics and, eventually, “clinician-rated patient safety.” This one goes beyond just communication. Every aspect of your personal and professional life will be affected by exhaustion (physical and emotional, of course). Another cup of coffee won’t be enough to stave off problems, so work with your team to find ways to recharge and stay on the same page with each other.