Communicating with Patients Tips

Shaw Somers

Shaw Somers is an award-winning consultant general surgeon at Portsmouth Hospitals NHS Trust with over 26 years’ clinical experience. He is also a founding director of Streamline Surgical, a specialist bariatric and general surgery provider to the independent sector. He lectures internationally on a variety of surgical topics. Here he shares his insight into patient communication.

Communicating with Patients

Mastering good communication habits is essential to avoiding misunderstanding and reduce the likelihood of complaints. The challenges of modern clinical practice in the era of increased duties of candour, disclosure and consent means the traditional ‘swift’ outpatient consultation is no longer appropriate. Patients rightly demand individualised care and discussion of options. If complaints and litigation are to be avoided, the ability to offer honest, empathic communication is key.

There are several pitfalls that can arise during doctor-patient communication including:

Using medical jargon: We can use complex medical terms that patients may not understand, leading to confusion and misunderstandings. This can make it difficult for patients to fully comprehend their diagnosis, treatment options, and medication instructions.
Lack of empathy: Doctors who do not show empathy towards their patients may be perceived as uncaring or insensitive, which can affect the patient's trust and willingness to disclose important information. This can also lead to a negative perception of the doctor and an increased likelihood of patients looking for a reason to complain about them.
Rushing the appointment: In a busy clinical environment, we may feel pressure to see more patients in less time. Important information can be missed or misunderstood.
Power imbalances: As doctors we can hold a position of authority, which can make some patients feel uncomfortable or intimidated. This can lead to patients not fully disclosing important information or asking questions.
Cultural and language barriers: Such differences between doctors and patients can create barriers to effective communication. Doctors not familiar with a patient's cultural background or language may unintentionally cause misunderstandings or misinterpretations.
Inadequate patient comprehension: Patients may not fully understand their diagnosis, treatment plan, or medication instructions. This can lead to non-compliance, medication errors, or unnecessary visits to the emergency department.

It is important to be aware of these pitfalls and take steps to mitigate them. This may involve taking extra time to explain medical concepts in layman's terms, actively listening, showing empathy, and providing patient education materials in a patient's preferred language.

Improving Communication

There are many sources of guidance on this important topic. The National Institute for Healthcare and Clinical Excellence has published a useful structure for insuring good patient management. I would encourage all clinicians to read this from time to time, to remind ourselves3.

Doctor - Patient interactions can now take many forms, and it is important to realise that each comes with their own challenges but, equally, carry the same responsibility for ensuring good communication.

In my experience, there is a recipe for enabling optimal communication between a patient and doctor - VISITOR. This mnemonic may be a helpful reminder of essential points to use with every patient.

V – Visual Aids: Use pictures or models. These can greatly enhance a patient’s understanding of their illness and proposed treatments – also prompt questions.

I – Introduction: Ask the patient how they would like to be addressed. This may not be obvious from the patient’s records. Asking how they wish to be addressed is a good ‘icebreaker’ question and helps gauge the patient’s state of mind from the consultation outset.

S – Share information: Offer copies of patient letters. Whilst a requirement under the Bishop of Norwich recommendations, it is polite to offer copies of the patient’s notes and letters and shows a willingness to be open regarding their care.

I – Involvement: Maximise patient participation by asking what the patient thinks of a sentence or statement or asking if they have understood the conversation so far. Both are valuable tools to avoid misunderstanding. Use open-ended questions to encourage discussion.

T – Time: Allow sufficient time for the discussion you are about to undertake with the patient. A simple discussion of a positive result can be undertaken in minutes. Explaining a serious or difficult diagnosis may take half an hour or more.

O – Office/Environment: Ideally, this should be private and undisturbed. While not always achievable at the bedside, it is important to try and make patients feel at ease with the consultation process.

R – Review: Summarise the discussion after important information has been given to confirm understanding and agreement. This prevents continuing the consultation when the patient has not understood important basics.

Read Back Technique

No matter how clear you think your communication has been, it is always wise to ensure that your message has been received correctly. The words you so carefully choose to use only account for a proportion of the patient’s understanding, your tone of voice and body language may be telling the patient a slightly different story.

A useful technique is employing ‘read back’, where a patient is asked to recount their understanding of the conversation and points of note. This enables further clarification to be given and allows you to confirm the patient's understanding of the consultation.

Many clinicians will develop a keen sense of when a consultation is not going well, or the patient seems not to trust what they have been told. Listen to those signals. In these circumstances it is wise to accept that communication has not been optimal, and that a second opinion might be worthwhile. It is polite to offer the names of consultants for second opinions (‘in-house’ or external), and to write letters to the appropriate clinician. Patients are entitled to second opinions and to feel confident in their doctor’s clinical approach to their treatment.

As always, the aim is to provide a good quality patient experience, whatever the clinical outcome. Maintenance of public trust in the medical profession and confidence in their carers is vital to the sustainability of our healthcare system.

Summary

Improving communication with patients not only reduces the likelihood of complaints but can also make practice safer. Estimates in 2019 indicated 27% of medical malpractice claims resulted from communication failures4.

Considering the key lessons I have taken from my years of practice, I would urge you to remember the following key points:

Outpatient Consults: Use checklists and proformas, give patients printed information sheets. Confirm understanding of the important points and summary of proposed treatment. The GMC’s 2018 report on Communication and Complaints5 found that it is important patients do not feel rushed or excluded from the decision-making process. Ensure you acknowledge the views of others the patient chooses to bring with them.
Bedside Consults: Be clear when addressing a patient and avoid distractions and interruptions. Ask if it’s OK to discuss personal and clinical information in that environment. Remember, patients are also interested in your attitude towards your colleagues as well as towards them.
Procedures: Confirm understanding of the diagnosis and procedure. Confirm agreement for treatment and understanding of risks and their implications during the consent process. Claims related to this topic tend to be the most serious for the doctors facing them and result in larger settlement values.
Be prepared to offer a second opinion if requested.