4 - Communicating with Patients Flashcards
The “fact” of patient experience
It is NOT our medical knowledge and skill that drive patient satisfaction of our care, it is our communication and connection
Patients assume that our knowledge and skill level is the same
Describe the role of the office environment in patient perception
- Patient perception of the office environment determines their impression of our quality
- Office convenience and appearance
- Team member interaction & communication
- Good patient experience goes way beyond a simple smile
What are the basic patient expectations of quality of care
- Accurate
- Consistent
- Evidence based
- Cost effective
Patients have no way to determine if we are providing the technical components of quality care
**The patients perception of their entire office experience is their proxy for determining quality of their care **
Describe the role of patient compliance
- Patient compliance with treatment recommendations is directly connected to connection with patients
- If we do not connect with patients they are not compliant
- If patients are not compliant, their outcome and the quality of care suffers
What are the assumptions that are made of non-compliant patients?
- Lazy
- Uneducated
- Don’t care
These are dangerous - they may not have the means to be compliant
Wall Street Journal
“People place more importance on doctors’ interpersonal skills than their judgment or experience, and doctors’ failings in these areas are the overwhelming factor that drives patients to switch doctors”
“communication is increasingly understood to be at the root of many of health cares failures ”
“lack of communication isn’t just frustrating for patients…. It hurts the quality of care, drives up costs and increases the risk of lawsuits”
Relationship between communication and compliance
- There is a direct connection between physician communication and patient compliance or adherence with treatment regimens
- High percentage of patients do not follow through because they do not have a trusting connection with the provider
Reasons most cited in malpractice claim
- Didn’t listen
- Didn’t return phone calls
- Showed little concern or respect for patient condition
- Rude
- Didn’t spend enough time
- Didn’t answer questions adequately
What is CG-CAHPS?
Consumer Assessment of Healthcare Providers and Systems
The thought is if communication is good quality of care will improve
**This will affect how you get paid in the future
How important is communication and connection?
There is a compelling body of data that indicates that communication and connection are as important to good patient outcomes as medical knowledge and technical skill
NEED to also teach your office staff this ***
What do patients want?
- Treats you with respect and dignity
- Listens carefully to your health concerns
- Easy to talk to
- Takes concerns seriously
- Willing to spend enough time
- Truly cares about you and your health
***** This list shows patients prioritize communication and connection they assume the technical quality is state of the art!!!!
Describe how you need to personalize for each patient
- Need to flex for each patient
- Some need quick, confident answers
- Some need a long explanation
- Quality of care can be the exact same, but if you change communication, satisfaction rates can sky rocket
Describe patient anxieties and fears
- 98% of physicians stated they discussed patients fears and anxieties
- 54% of patients said their physician never did this
Describe the patient diagnosis understanding
- 77% of physicians believed the patient understood the diagnosis
- Only 57% of patients actually knew the diagnosis
Describe “adherence” vs “compliance”
Less negative connotation with “adherence” so use that instead of “non-compliance”
Describe how good connection drives adherence
- 26% failed to mention the name of a new medication
- 13% failed to mention the purpose of the medication
- 65% failed to review adverse effects
- 66% failed to tell the patient duration of treatment
Describe what poor communication results in
- Mistrust
- Errors
- Poor productivity
Misunderstandings are a common cause of work place dissatisfaction
Good communication facilitates a comfort and trust between team members
Quote on medical organization success
“It is amazing that so much of a medical organization’s success or failure rides on the conduct and performance of it’s physicians, and yet so little time is spent providing physicians the tools and training that are the requisites for this success”
Describe the non-intuitive nature of communication skills
- These skills are not always intuitive
- We may have no idea the impression we are giving to our patients
- 74% of patients are interrupted by the doctor within the first 17 seconds of the initial history
- 91% did not participate in decisions regarding treatment plans
First, let them get their story out, then ask questions - Don’t interrupt - This will actually take LESS time
If you are going to change your level of communication skills
- Must be able to self reflect and recognize how we are acting and communicating
- Need the desire to change and improve
- Must have a growth mindset
Describe need for self-assessment
- For every customer that complains, 20 dissatisfied customers do not
- Of those that are dissatisfied but don’t complain 90% do not return
- It is 10 times more expensive to recruit a new patient than to keep existing patients
- The average dissatisfied customer will tell 25 others
What are the components of communication?
- Verbal
- Listening
- Empathy
- Non-verbal
- Validation of the patient concern
Describe verbal exchange
What we say, and also how we say it
Describe listening
Just as important as talking
Describe empathy
Must try to understand the patients mindset, emotions and fears
Describe non-verbal
- Body language
- Environment
- Personal emotions and stress
What are the barriers to good communication
- Stress and emotions
- Personal Bias
- Lack of focus (don’t multitask, don’t stare at the phone or computer)
- Poor or inconsistent body language
- Outright negative body language (crossing arms, tapping fingers or feet, avoiding eye contact)
Describe the basics of verbal communication
The easy part
- Speak clearly and confidently
- Use lay terms
The hard part
- Listen
- Set aside personal bias and judgments
Describe rules to follow for trust and empathy
The other person must feel listened to or there will be no trust
- Do not multitask
- Try not to interrupt
- Don’t immediately judge
- Nod or acknowledge your understanding with a word
- Offer a positive comment if the patient has had success
- Paraphrase what the patient is saying to assure understanding
Empathy
- Try to understand the other position and emotion
Describe the benefits of active listening
- Improves understanding
- Improve productivity
- Develop trust and true connection
- Avoid errors
- Avoid conflict
What is necessary for high quality care?
Must deliver on three components of communication to make the connection that results in consistent outcomes
- Information
- Motivation
- Strategy
Describe how to deliver information
- Consider patient cognitive ability when delivering the level of information
- Avoid excessive amounts of information (highlight key points)
- Emotions (Patients may not prepared to absorb information due to fears or worries)
Describe patient motivation
- Patients will only follow advice they believe
- Patient needs to understand the importance of the treatment or condition to be motivated
Describe the importance of motivation
- Shared decision making helps motivation
- Involve the patient in the decisions
- Motivation fades in time
- Must have reinforcement
Describe patient strategy
Must have a plan
- Clear
- Organized
- Uncomplicated
- Realistic
Must identify barriers patient may have to understanding and complying
- Language
- Cultural (taboos, embarrassment, support)
- Social (transportation, home factors, financial)
Validate the patients concerns
What are the verbal “don’ts”
- It’s one of those days around here……..
- That’s not my job the front desk is always forgetting this……..
- I have know idea why they sent you……
- We just can’t get good help……..
- They should not have told you that……..
- I hate these computers………..
- Administration told us that this was the way it has to be done…..
Be positive - don’t voice these opinions
Describe how to position team members and the organization
- Negative comments about someone else in the office or about the organization does not make you look better, it makes the patient question the overall quality of care, which includes you
- Positive comments on the other hand make individuals and the organization look good and this fosters trust from the patient
What are the verbal “do’s”
- We have a great team here…
- Let’s see if we can get that answer for you…
- Thank you for waiting for us…
- We are excited about our new system and how it will improve your care, we are still learning and it may take a minute or two to get your records updated…
- Our lab is excellent, I am going to send you down for your blood draw, they will take great care of you…
What are the non-verbal basics
There is no second chance for a first impression
- Face the patient
- Eye contact
- Handshake
- Sit down
Open posture
- Lean in
- Palms up
- Arms open
Never
- Arms crossed
- Looking away or down
Describe the quality of the hand shake
You are judged instantly by the quality of your handshake
- First impression!!!!
Describe the respect for personal space
- Region surrounding a person that they psychologically regard as their own
- Any closer than an arms length is interpreted as aggressive or intimate contact
How do we respond when someone enters our space?
- Discomfort
- Anxious
- Anger
Describe the first impression
- Important for every member of the team
- You don’t get a second chance
- When you enter the room, knock twice, pause, then enter
- Don’t assume the patient understands what you are doing and why
- Most things at the doctors office are a mystery to patients and this mystery fuels fear and distrust
Describe how to be prepared for an important
BE PREPARED
- Make sure to review the record prior to entering the room
- Tell the patient what you know about their condition, what you have reviewed
- Reference the referring doctor and the work up or treatments done to date
- Another opportunity to manage up!!!
Describe how to take a history with good communication
- Know the background
- Invite the patient to voice their concerns
- Average physician interrupts after 17 seconds
- If the patient is not allowed to talk they immediately become defensive and trust is broken
- Let the patient talk 2 minutes
- Validate the patients concerns
- Do not belittle or put of their concerns
- Do not be judgmental (verbal or non verbal)
- * If you are looking away, looking at computer or not responding the patient thinks you do not care*
- Many times communication issues are underpinned by a personal concern in the patients life
Describe good communication during the physical exam
- The silence of the exam is uncomfortable
- This is a prime opportunity to educate the patient and gain trust
Describe how to close
Summary should be given at each team member contact
Review what and why for each
What is AIEDET?
A = Acknowledge I = Introduce E = Explanation of exam D = Duration E = Explanation T = Thank you
Describe acknowledge
- Show respect
- Our professional image is perceived in the first 2-3 seconds of contact – No turning back the first impression
- Acknowledge all people in the room
- Immediate eye contact
- Shake hands
- Body language
Describe introduction
- The patient wants to know who we are but they will likely not ask
- Yourself and the role on the team
- The practice
- Short background and skills
- Positively position the practice and others
- Never give excuses or complain about people, systems, departments or technology
Describe explanation of exam
- Removes the mystery, Fosters trust and confidence
- “I am going to check a few basic things first like your circulation and your sensation as well as checking your joints and muscles, once I finish the basic exam we will look at your current problem and figure out a solution together. ”
- Tell the patient the findings as the physical exam proceeds and if any abnormalities discuss the significance
Describe duration
- Sets the expectations, removes mystery
- How long is the wait
- How long will the procedure take
- How long until the next person or provider arrives
- “A few minutes” or “shortly” is not good enough
- Give specific, realistic and deliverable time estimate
*** Patients don’t know what is going to happen next, need to be specific
Describe explanation
- Removes the mystery, Fosters trust and confidence
- Summary of the interaction
- Clear and concise in lay terms
- Why you are recommending, prescribing or performing
- What to expect now and later
- Make sure they understand before proceeding
- Information, Motivation & Strategy
Describe thank you
- For choosing our practice
- For trusting us with your care
- For being patient
- For being courageous
- One final chance to ask for questions or concerns
- Not “do you have questions”
- Better “what questions do you have, there was a lot or information today, I want to make sure you understand so that you get better”
Closes on a positive and collaborative note
Describe how to deal with difficult encounters
Sometimes things just don’t go well
- Poor first impression
- Bad day
- Unrealistic patient
- Underlying emotions
Take a step back and a deep breath and re-evaluate your reaction, your motives and the patient
- Why is the patient upset
- Empathy
