Surveys suggest doctors and patients often fail to communicate effectively, so public and private medical organizations have implemented programs to improve “patient engagement”. But what exactly does that mean?
The communication problem
Patients may feel that doctors don’t listen to them, ignore their questions , dismiss their concerns, don’t spend enough time with them, and don’t use language they can understand.
Physicians wonder why patients withhold important health information, fail to follow up with recommendations, and don’t ask questions or express their concerns.
The main problem with health care communication is that it involves people- and people frequently communicate poorly, and sometimes not at all. It never will be perfect. But we can do better.
So what is true patient engagement anyway?
Dr. Rob Lamberts writes
“Engagement is about interaction, listening, and learning in relationship to another person.”
Barbara Ficarra, R.N. , puts it this way:
“Patient engagement is a connection between patient, caregiver and health care provider.
Patients and their families are empowered and they are active in health care decisions.
Those patients and consumers who choose to be actively involved and in charge of their health work together with their health care providers to successfully rech their health goals and needs. “
To make healthcare interactions more effective, efficient, and empowering, both doctors and patients need to develop skills that may be different from what they have done in the past.
What is communication?
to convey or exchange information, thoughts and feelings.
to join or connect.
Establishing a connection, or relationship.
If we try to start exchanging information, or even thoughts and feelings before we have established a connection, it is like to be unsatisfactory.
For example- think about a recent retail service experience – one that worked and one that didn’t. Perhaps it was a call to customer service to get a phone service problem resolved. Or maybe you went to a car dealership and interacted with a sales person. Whatever the situation, and whatever the outcome, you probably rated it more favorably if you felt connected with the person helping you.
Recently I called my medical insurance carrier to resolve some unpaid claims- and my insurance is through a government agency. I dreaded the call, expecting a difficult unpleasant conversation. But the rep was professional, efficient and confident. She started immediately by telling me her name and position, then asked me my name. She then accessed and reviewed my account, giving me feedback about what she found. Then we started working on my problem, and continued until it was resolved. I was surprised to have the situation taken care of not only efficiently but pleasantly.
the who of connection
Customer service depends on connecting, and that usually starts with knowing who you are dealing with. The first item we exchange in any human interaction is usually our name.
You should learn your doctor’s name and credentials-M.D., D.O., and specialty- internal medicine, cardiology, psychiatry, etc. in other words, what kind of doctor are they?
What is this doctor’s role in your care? Is this doctor primary or a consultant, and what issues are each managing? (especially in a hospital situation)
Tell your doctor what name you prefer to be called if it’s different than the name on file. Your doctor should know who is your legal next of kin or who has POA (power of attorney if applicable)
Introduce other family and friends and identify the primary contact person; this first level of receiving and giving information, is especially important in the hospital setting. This will create continuity as the doctor speaks to the same person every day.
If you take a friend or relative to your doctor’s office with you, make sure they understand what their role is. Your family’s insights and observations provide helpful information to supplement what your doctor learns from you. They can help you remember and understand answers and instructions. But this isn’t a time for them to discuss their own medical issues with the doctor.
the where of connection
Where you interact with your doctor, is important as interaction may be quite different in a private office setting vs an urgent care clinic vs an emergency room vs inpatient. But general principles apply to all settings.
Ideally it should be as comfortable as possible, private, and quiet, so you can hear and see each other well.
Friendly greetings are fine anytime you encounter your doctor, but discussions of personal medical information don’t belong in the hallway, elevator, or cafeteria. Likewise, if you run into your doctor at church or the grocery, just say hello.
the how of connection
Come to an office visit prepared. If you have test results, previous medical records, xrays, etc. bring them with you. Not all doctors will request it, but most will appreciate an up-to-date list of all medications you take, or even bringing the meds with you. Turn off your phone.
Expectations about time can create conflict, whether the visit lasts longer or shorter than you expect. If you weren’t told, ask the office how long the appointment is for, realizing that it will only be an estimate; it will depend on what you and the doctor end up discussing and what you need done.
Showing up on time helps the office keep to their schedule and shows the doctor you are serious about your care and respectful of other patients’ time. If the office is consistently poor at time management, address it respectfully; sometimes it is best to move on if this continues to be an issue that bothers you.
Most hospitals and clinics have abandoned paper charts for computers, using electronic health or medical records- EHRs or EMRs. I’m not going to dwell on it now, but computer use in the exam room or bedside has changed the dynamic between doctors and patients in ways that were unexpected and challenging. Here is the link to a post I did addressing the issue of
the value of connection
Connecting with your physician depends on acknowledging feelings- worry, fear, despair, hope, relief, anger, resentment, frustration. Give feedback respectfully; if anything about your care is not as expected, or doesn’t seem appropriate, or you just don’t understand something, speak up.
Expressing feelings honestly and respectfully, and listening with empathy and respect can build the trust that is vital to creating a connection for effective information exchange – communication.
Dr. Jonathan Weinkle discusses connection and relationships in his book
which I reviewed at this link.
exploring the HEART of communication
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