October 1999 Bulletin
Ten tips for better communication
- 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.
- 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
- 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.
- 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.
- 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.
- 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.
- 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.
- Pause when a patient speaks, nod, smile, say "hmmm"
or "tell me more about that." Let them know that you're
- 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
- 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.