3 Ways We Can Improve Communication With Our Patients and Beyond
We all know how communication is the foundation of relationships. Communication establishes trust and is a means for us to understand each other. Today in the physician community One of the things we battle is the challenge of patient adherence. While there are many reasons we know patients will not adhere to our recommendations, it's conceivable that part of that is due to a lack of patient trust. If we were to allow ourselves to be responsible for our part, it could be that our communication is not conducive to establishing and maintaining this trust with our patients. Now, if you're saying to yourself, "but I take the time to explain to patients The risks, benefits, and the alternatives of…" , Or if you're saying, "I educate my patients in every visit…", you're definitely on the right track, but don't exclude yourself from this conversation. As I speak of communication in this context, I am speaking of more than the informational spewing of words. There are several components to communication that are important and if we are not aware of all of them, then we could miss the cues that would allow us to effectively connect with patients. In another article I go into more depth about the various components of communication, but in this article I will share three simple things to remember when engaging your patients (or anyone for that matter) that will further demonstrate that you care about your patients (because I know that you do), and will build a bridge to A more open dialogue between you and the person to whom you're speaking.
- Take Time to Build Rapport - when most people think of rapport, they think of the surface, "hi, how are you doing… Small talk, small talk, Small talk….” Well that is a component, rapport is much more involved than the language itself. When you take time to build rapport, it is the nonverbal way of establishing trust between you and the person that you are speaking with. Now, it's important to be aware of cultural cues when taking on establishing rapport with a patient so as not to inadvertently disrespect or offend him. Part of this I will discuss in the last point of this article, when I talk about respecting person's model of the world. However, one of the most basic ways to establish trust is through body language. A technique called matching, in which you (in a subtle way) match the body language and energy of the person you're with can increase relate ability. So, if the person you're speaking with is more relaxed in their posture, and their speaking (pacing and tonality), you can match them subtly by being in a more relaxed state as you speak with them. Conversely, if they are more assertive in nature (they may be sitting for the new chair, making eye contact, and hang on your every word) you want to match that. Similarly mirroring is a way to get in rapport with someone. Mirroring is simply mimicking the body language of the other person. Again, you want to be rather subtle about this, as if you are too literal in this, they may think that you're mocking, and this could offend him. However, using the subtle techniques along with the pleasantries of getting to know your patience will increase the patient's ability to connect with you as a person who cares about their wellbeing. Remember, patients don't care about how much you know until they know how much you care.
- Listen to More Than Just the Words Coming Out of a Patients Mouth - Listening is a very powerful component to communication that is often overlooked. Furthermore, the way we listen makes a huge difference in our being able to reflect not only what is being said, but the commitment behind what is being said. Listening behind the words is a skill that most people (and particularly us physicians) don't take the time to learn, and for many of us who already have the skill we don't always take the time to exercise that muscle. However, how many times have you been speaking with someone, and when they reflect to you what they heard it causes you to really feel like they get you? If you have that experience, then you have spoken with someone who was listening to more than just the words that are coming out of your mouth. Many times patients will come in for simple complaints, such as fatigue, common cold, insomnia, etc. Sometimes the condition is simply the condition and sometimes there's something more that is at play that has them come to you. You might say to yourself, "Well why don't they just say it then?" Well, can you think of the time when you wanted to express something, but you didn't know how? Better yet, have you ever felt just "off" and it wasn't until you were talking with someone who was truly listening to you that you figured out what was really going on underneath the superficial complaint? We have the opportunity to heal patients beyond the surface conditions that bring them into our office, and contrary to belief it doesn't take a very long time to hear what's underneath the surface if we truly take the time to listen for it. Even if you are in a busy practice, listening is probably one of the most therapeutic services that you can provide for your patients. They may not have anyone else or (think they have anyone else) with whom they can share their fears or concerns. They may feel ashamed to talk about these things with anyone else. They may feel that something in their livelihood could be threatened if they talk to anyone else but a physician about it (think about why we as physicians often don't report our own emotional/mental turmoil). Now, a pitfall here could be that when you DO hear something under the surface and you jump straight to FIXING the problem (i.e. prescribing antidepressants or referring for therapy) rather than further listening, and even asking them what they think they need. While your recommendation is valuable (and there is nothing wrong necessarily with fixing), if you jump straight to FIXING, you may miss the opportunity to HEAL. Listening is a VERY HEALING process for most people and often just being able to get it out in the open gives a patient access to next steps. So, the key here is that if you hear something beneath the surface, avoid jumping straight to FIX IT mode. By take the time not only to listen to what the patient is saying, but with the patient is NOT saying, and then empowering them in a way that works for them, you will not only be able to address the real issue, but you will earn the patient trust and confidence at a new level.
- Respect the patients’ model of the world EVEN if you don't agree. Now I know that this one may be difficult for some people, because we have our opinions of what's right, what's smart, what's necessary, and what works. However, if we want to be able to convince a patient that a particular treatment may be good for them, we must first be able to respect their model of the world. A patient will absolutely not listen to a physician who is simply firing off commands without any understanding of their values & belief system. They may smile and nod their head, but the moment they walk out of the door everything that you said has "left the building" with them, and some of these patients will even go and find another doctor who they think could better understand what they are experiencing. I know this because I've seen these patients as have some of you. The key phrases to look out for in these patients are, "the other doctor didn't listen to me ", "The other doctor that I saw was condescending", or "disrespectful", or "brushed me off…" when you hear these phrases, it is likely that their last doctor was not being sensitive to their values. This is not to say that respecting the patients’ model of the world means that you have to buy into it, it just means that you get it, respect it, and allow for their differences. When speaking to a patient, it may sound something like this, "I understand you like a more natural approach to your health, AND (rather than "but") there is benefit to utilizing this aspect of medicine as well. Would you be willing to try both together?" This is just an example of a conversation, and I understand that patients can be more complex than this, however in this conversation you may elicit a fear that can help you understand the resistance, and even further educate and convince the patient to accept your recommendations and follow them. This is the value of respecting their beliefs & model of the world. They can see that you are person who cares about their well-being as a person. Remember, patients don't care about how much you know until they know how much you care.
As I stated earlier, I realize that this is the tip of the iceberg where it comes to patient communication and engagement. There are multiple factors in having our patients be more adherent to our recommendation. Take these three points as an entry point to improving the overall trust and connectedness between physicians and patients. This may be the first step to healing the disconnect that has been ensuing for quite some time now. Furthermore, utilizing these three tips can be a pathway to empowering our patients in a way that will ultimately have them be more adherent, improving long-term outcomes in our health system.
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