Communicating in Healthcare Settings
By Mariana Nicolaides, MPH Candidate, Associate Editor at Arizona Physician
Digital Exclusive - March 2022
Possessing strong communication abilities is one of the greatest skills any individual can have. In the world of healthcare, effective communication not only strengthens relationships and trust between professionals and patients, but also prevents injuries and in some cases death. According to CRICO Strategies Research (2016), 30% of all malpractice claims filed between 2009-2013 were due to poor communication in healthcare settings, and 37% of all high-severity injury cases involved a communication failure. This transaction of giving and receiving information is a foundation of patient safety and is a crucial skill that one must have when working in healthcare.
Physician to Physician
When working together, accurately exchanging information is vital, as the health and wellness of patients depends on it. To improve workplace communication, organizations should prioritize communication, making it a core value, and if possible, offer engaging communication training for clinical and non-clinical staff (Awdish & Berry, 2020). Creating goals with staff and normalizing communication can help build trust and teamwork, which can lead to identifying issues happening with patients or in the workplace. Current methods of communication should be identified, and a list should be drafted to see where improvements can be made (Clark, 2021). For example, healthcare professionals can better communicate together through streamlining communication channels. If information is shared in multiple ways to multiple individuals, information is bound to lose consistency over time.
Taking steps to improve communication between staff is necessary for improving patient care and outcomes, but according to Ronald M. Epstein, MD, director of the Center for Communication and Disparities Research and professor at the University of Rochester Medical Center, physicians building relationships between each other is an essential ingredient for communication and care coordination (Shannon, 2012). For many, the increased distance between physicians has weakened relationships and created the issue of communication gaps (Shannon, 2012). To quote Dr. Epstein, “Fewer and fewer primary care physicians admit to hospitals, and there are no venues for them to meet the cardiologist, the nephrologist, the radiologist. It used to be that when I saw an X-ray reading, I personally knew that radiologist. I knew what his or her skills were. I knew what they really meant when they said ‘clinical correlation needed’ or ‘might consider an MRI scan.’ Now I don’t really understand the intent of some of the messages that I read in the chart.”
Physician to Patient
Poor patient outcomes are often due to lack of communication, and research has found that caregivers who use these skills are more likely to have patients who follow through with medical recommendations, self-manage chronic conditions, and adopt preventive health behaviors (IHC, 2011). Studies have found that a clinician’s ability to listen, empathize, and convey information has a profound effect on biological and functional health outcomes as well as a patient satisfaction (IHC, 2011). Building and maintaining trust with patients is a crucial part of providing care, as patients are more likely to feel comfortable and disclose information they may not have otherwise revealed. To build trust with patients, physicians should be knowledgeable in what they practice, sharpen their social skills, keep information confidential, and show patients honesty and respect (Allinson & Chaar, 2016).
Constant distractors that force physicians to spend less time with each patient have left many to experience burnout and degradation in effective patient-physician communication. One way a physician may improve these issues is by practicing mindfulness. A study with primary care physicians found that those who had participated in a year-long mindfulness practice program not only increased their resilience, but improved quality of care and patient interactions (Yip, 2017). Dr. Epstein mentions four mindfulness skills that can assist physicians in improving communication to provide quality care: attention, curiosity, presence, and beginner’s mind. The first skill, attention, is essential. With ample things on a physician’s mind, being fully attentive to a patient may be difficult. Practicing mindful attention to slow down and not rely on automatic fast thinking can be helpful when patients are presenting signs of something serious. The second skill, curiosity, inspires physicians to ask questions and better understand a patient’s needs, circumstances, and values. Having the full picture of the patient can help physicians offer more personalized solutions that can provide better outcomes. For example, physicians should present information in a way that the patient, who most likely is not a health expert, will understand. Data from 2016 shows that in 2011, it was found that at baseline, only 64.1 percent of individuals 18 years and over reported that instructions from health care providers were easy to understand (See Figure 1) (ODPHP, 2021).
The quality of human interaction matters and how information is given differs for each individual due to personal factors such as one’s nature, stress, knowledge, biases, and past experiences (Laskowski-Jones, 2014). While these factors have a role in how individuals communicate, it is important that healthcare providers tailor their communication style to better help patients. The third skill, presence, gives physicians the ability to listen deeply with no judgment, interruption, or preconceptions. A physician’s presence can help the patient to feel acknowledged, understood, and therefore decrease the chance of miscommunication and error. Lastly, Dr. Epstein recommends that physicians have a beginner’s mind, meaning that physicians should “be aware that their understanding of a patient’s case, while based on expertise, may be provisional and incomplete” (Yip, 2017).
Telemedicine and Telehealth
In the last few years, the way many give and receive healthcare has changed, and these digital landscapes, telehealth and telemedicine, have become increasingly popular. Telehealth uses technology to facilitate long-distance health care, education, administrative teamwork, and disaster responses. Telemedicine is a subset of telehealth and specifically involves offering clinical services to patients at a distance, such as teleconference exams and shared diagnostic data, and conversations through the phone or computer (du Pre, 2017). An ongoing 2021 study conducted by the National Center for Health Statistics (NCHS) and the Health Resources and Services Administration’s Maternal and Child Health Bureau (HRSA MCHB) found that nearly one-fourth of survey takers had an appointment with a health professional over the phone in the last 4 weeks of taking the survey (See Figure 2) (CDC, 2021).
Some physicians may find that conveying important information over a video call and providing care they would typically do in person on a computer frustrating, and many may feel as though they are not providing the same standard of care. While this may be a barrier for some, there are numerous ways to prepare physicians who are beginning to offer these services. According to Melanie Esher-Blair, MADM of the Arizona Telehealth Program, “Developing your screen side manners in today’s telehealth world is just as essential as developing good bedside manners. Patients still need to feel they are being heard and understood by their provider whether in-person or via video connection.” When conducting a video visit, physicians should make sure to project confidence and look the part. The physical space should be well lit, clear of distractions, and private to create a sense of warmth and safety. These small changes can help patients feel confident in the physician they are seeing, and therefore patients will be more likely to listen to the information being conveyed (Goold, 2002). Establishing rapport and having empathy for patients are also vital components of communication and can still be done over the phone or computer. Physicians should look into the camera, maintain eye contact, and place all focus on the patient to create an inviting space for all (Heath, 2020).
According to ODPHP (2021), “Ideas about health and behaviors are shaped by the communication, information, and technology that people interact with every day.” It is important that healthcare providers tailor their communication style to their patients, and that they have data on the population they are serving. Whether it be in the office or over the computer screen, physicians can improve care and patient outcomes through effective communication.