What is more detrimental, and even more critical, is the resulting deterioration in physician-patient relationships. Collectively and individually, physicians are losing some of their capacity to form connections that are not only essential for an excellent patient experience but also for quality of care and safety. Quite simply, the demands of their work and the lack of effective skills to address them strain physicians' ability to consistently deliver care in an efficient, caring, high-quality fashion.
Restoring relationshipsOrganizational culture determines how health care providers interact with one another and their patients. More and more physicians are losing the ability to be present in their work, foster meaningful conversations and navigate emotional challenges.
Improved efficiency and effective patient engagement are often treated as if they are mutually exclusive. But through my experience as a physician and instructor, I have seen the power that several simple but fundamentally important skills can have on the physician-patient relationship. Rather than being an inevitable casualty of the changing health care environment, patient engagement is the road to improved efficiency, quality, safety and financial stability. Equipping everyone with the skills needed for success will improve culture, quality, patient experience, and provider and staff satisfaction as well as reduce physician burnout.
Your health care team members need five skills to restore relationships in their own practices:
- Presence and mindfulness.
- Reflective listening.
- Information gathering and agenda setting.
- Recognizing and responding to emotion.
- Gratitude and appreciation.
Presence and mindfulnessThere are innumerable tasks competing for a physician’s attention. Not being in the moment can lead to distractions, and what may seem like innocuous occurrences can have lasting and devastating results. Fifty percent of preventable errors result from breakdowns in communication among members of the care team, according to the Institute for Healthcare Excellence. Breakdowns can range from the dramatic (a wrong-site procedure) to the more subtle (a patient who leaves saying: “That doctor is probably pretty good, but you can’t talk to him. He didn’t seem to want to know my concerns.”) These instances, repeated from provider to provider, further erode patients’ trust in the health care system.
Statistics such as this are not surprising given the increased complexity of communication in health care. However, effective teams overcome these complexities by practicing presence and mindfulness.
Both formal and informal practices of teaching presence and mindfulness are readily available. For example, strong communicators understand that you must be present in the moment to be effective. Taking a deep breath and time for calm before knocking on the exam room door can take physicians to a place of presence.
Reflective listeningEncourage your physicians and care team members to try this sometime in their next encounter with a co-worker, patient or even family member: Actively listen. See what happens when you do not interrupt — at all — and just listen. Don’t click through the electronic health record. Don’t review the chart in front of you, read emails or look at your phone. After you’ve listened, reflect what you heard back to the person.
If care team members practice these skills they’ll be astonished to discover how valuable it is to feel heard as well as how much information they can obtain in a short period of time. This skill is not just about making others feel good: The degree to which patients can tell their own stories affects outcomes. Headaches are more likely to resolve. Hypertension improves. Patients miss less work.
Information gathering and agenda settingThese are really two skills but are inextricably combined. Pressed for time, physicians often find themselves immediately launching into the details of a patient’s first complaint. Studies have shown that it is often the second or third complaint that is of greatest importance to the patient.Is it any surprise, then, that studies have also shown that 80 percent of patients feel their doctors are too busy to listen?
Encourage physicians to take this alternative approach instead: First, solicit the patient’s list of concerns. Don’t go into detail. Just elicit the list. Say, “What else?” Once you have the response, work with the patient to determine what will be done during the encounter. The output looks more like: “We agree problem A is important. You expressed concern about B, and I would also like to address C.”
Think about how this scenario could greatly improve the patient-physician relationship.
Recognizing and responding to emotionTeaching physicians and the care team how to recognize and respond to emotion can be the most intimidating communication skill but is often the most valuable. Too many times, physicians find themselves in front of frustrated patients or having a difficult conversation with a co-worker. Knowing how to identify the friction, acknowledge it and address it is critical to any relationship.
First, take some time to recognize the emotion: “You look frustrated (confused, angry, upset, etc.).” Then, respond, perhaps with a helpful tool I’ve used in my physician training. The tool is called "PEARLS":
- Partnership: “Let’s tackle this together.”
- Empathy: “That sounds hard.”
- Apology/Acknowledge: “I wish I had better news.” “Sorry I was late.”
- Respect: “That was tough. You handled it well.”
- Legitimization: “Anyone would be (confused, sad, irritated) by this situation.”
- Support: “I’ll be here when/if you need me.”
Gratitude and appreciationHow often are you thanked for your work? When it happens, how does it feel? How often do you give sincere thanks to your colleagues, your physicians or staff? If you did that more, how might it affect the strength of your relationships? Simply showing appreciation regularly builds and solidifies long-lasting, productive relationships.
These skills are simple but require purposeful development and implementation. It is easy to lose them in the midst of hectic days and increasing demands. With consistent practice and use in clinical, professional and personal lives, these skills are a path to stronger physician-patient relationships and a shift in organizational culture. With that foundation, improvements in quality, safety, efficiency and patient experience can flourish.
Timothy Poulton, M.D., is a family medicine physician with Mission Medical Associates, part of the Mission Health System in Asheville, N.C. He also serves as faculty for the communication in health care curriculum at The Institute for Healthcare Excellence.