Patient Communication: Tips for a Successful and Open Dialogue

Ashley M. Egan, MD, and Kelly M. Pennington, MD

June 12, 2020

Effective communication with patients and their family members is an essential skill for physicians. Just as gaining proficiency with central line placement or bronchoscopy requires technical supervision and repetition, learning to be a good communicator entails intention, practice, and introspection. Think about this:

• Nearly one-half of American adults (90 million people) have difficulty understanding and using basic health information.¹
• According to a report by The Joint Commission, communication failure is associated with more than 70% of serious adverse health outcomes in hospitals.²

Although much of our training is devoted to learning the technical or scientific aspects of medicine, the way we present ourselves to patients through our words, body language, and writing has a profound impact on patient care.

It was during my intern year that I realized just how much my ability to communicate with patients mattered. I was seeing Ms. C* in the primary care clinic for a hospital follow-up visit. I recommended adjusting her newly prescribed beta blocker from a twice-daily, short-acting regimen to a once-daily, long-acting regimen. I hurriedly wrote the prescription, recited the directions, and ran off to see my next patient. Less than 1 week later, I was notified that Ms. C had been hospitalized with bradycardia and hypotension. She had continued her short-acting beta blocker and started the long-acting agent.

In this scenario, there’s the obvious communication error that occurred with adjusting Ms. C’s medication regimen. But, there’s much more to be learned from that one brief interaction. Let’s break it down.

Develop Effective Communication Skills

For most of us, medicine has become our primary language. It’s how we communicate, day after day, with our colleagues. Most of us unintentionally use medical jargon when communicating with patients. It takes a conscientious effort to use plain, nonmedical language.

Tips to help convey information in a manner that patients understand include slowing down; “chunk and check,” which involves organizing information into a couple key concepts and then checking for understanding; and asking for teach-back.³ With full patient panels, we often worry we won’t have time for these steps, but studies have shown that physicians who use the teach-back method actually save time and may even reduce the frequency of future appointments.³

Using the “Ask Me 3” guide to concluding patient encounters is also incredibly useful.⁴ At the end of every appointment, ensure your patients can tell you the answers to these three questions:

1. What is my main problem?
2. What do I need to do?
3. Why is it important?

Discussing Adverse Events

In your career, if you never cause patient harm because of a medical error, you’ll be in the minority of health-care professionals. Medical errors are the third-leading cause of death in the United States.⁵ Disclosing errors is difficult to do, but studies have shown that doing so increases patient satisfaction and reduces the number of lawsuits.

So how do you go about it?

Petronio et al⁶ outline how to approach such conversations, and we encourage you to read it. Most importantly, apologize. An apology not only conveys your regret for harming the patient, but it also demonstrates your acceptance of responsibility and desire to remedy the situation. Take a page from Robert Fulghum’s bestseller, All I Really Need to Know I Learned in Kindergarten: "Say sorry when you hurt somebody."

By no means will these tips make you a master communicator, but hopefully they will help guide your next patient interaction and be useful in reflections on past encounters. Developing communication skills is a lifelong process—one that you will continue to refine over the course of your career.

*Story adapted to protect the privacy of the patient.

References

1. Osborne H, Willard A. Use language your patients understand – improve how you communicate to enhance patients’ health literacy. Private Practice Success. 2007:5(8):2-4.
2. The Joint Commission on Accreditation of Healthcare Organizations. National patient safety goals. http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals. Accessed May 27, 2020.
3. American Medical Association (AMA). Health Literacy and Patient Safety: Help Your Patients Understand. Chicago, IL: AMA Foundation; 2006.
4. Graham S, Brookey J. Do patients understand? Perm J. 2008;12(3):67-69.
5. Carver N, Gupta V, Hipskind J. Medical error. In: Abai B, Abu-Gosh A, Acharya AB, et al, eds. StatPearls. Treasure Island, FL: StatPearls Publishing; 2020.
6. Petronio S, Torke A, Bosslet G, et al. Disclosing medical mistakes: a communication management plan for physicians. Perm J. 2013:17(2):73-79.

About the Authors

Ashley M. Egan, MD, and Kelly M. Pennington, MD, are third-year pulmonary and critical care fellows at the Mayo Clinic in Rochester, MN, with a special interest in patient-physician communication. Dr. Egan’s research interests are in medical ethics and interstitial lung disease. Dr. Pennington’s research interests are in lung transplant and pulmonary infections. They enjoy (trying to) complete escape rooms with their cofellows.