October 1999 Bulletin

Ten tips for better communication

1. Sit down when interviewing a patient, and make sure your stool is low so that you're looking up at the patient, not down. This subtle difference helps to equalize the "power imbalance" inherent in the doctor-patient relationship.
2. If you introduce yourself as "Dr. [fill in the blank]," but use the patient's first name (thinking this will create an informal atmosphere), you may be taking a risk. Some patients see using their first name as putting them "one-down."
3. Try not to interrupt for the first two minutes of the initial encounter. The average doctor interrupts after just 18 seconds; most patients never return to their original train of thought, and important information could be omitted.
4. Ask open-ended questions such as "How are you?" and "How did that make you feel?" Studies show that open-ended questions do not take more time, as often feared. They may even allow the patient to get right to the point.
5. Instead of asking, "Do you have any questions?"ask, "What questions do you have?" You'll get a very different response, especially from reticent patients.
6. Acknowledge the patient's emotions. It's natural for patients to experience fear, frustration, anger, or loss. Even simple comments such as, "You look scared, what are your concerns?" can make a big difference to the patient.
7. To make sure you've heard the patient correctly, paraphrase the key thoughts and ask the patient whether you've captured his or her concerns.
8. Pause when a patient speaks, nod, smile, say "hmmm" or "tell me more about that." Let them know that you're listening.
9. Keep waiting room times to 22 minutes or less. This is the "magic" number, after which patients begin to feel irritated. If patients are kept waiting too long, they will likely be angry (openly or secretly) before the doctor even walks into the exam room.
10. If you sense that a patient is angry or annoyed with you, be up-front about it. For instance, say, "I get the impression that you're angry with me, may we discuss this together?" or "I want to solve this problem we seem to be having. My thoughts about the situations are [fill in the blanks]. What are your thoughts? Is there something I can do at this point to help up work together more effectively?" Treating patients as an equal partner in decision-making is strongly associated with patient satisfaction and better health outcomes.