Doctor Offers Patient-Communication PEARLS

      WASHINGTON — More than a third of physicians find at least 25% of their patient interactions to be quite frustrating, and about 8% of physicians say they find at least half of their consultations frustrating.
      Good communication skills can help equip physicians to cope with patient behaviors and personalities the doctors find challenging, and those skills can be learned, said David J. Gullen, MD, at the annual meeting of the American College of Physicians.
      “We estimate that in a 25-year career, we could have roughly 250,000 patient encounters. … Even if we had a very specialized, proceduralized practice … we still would spend more time talking to patients than actually operating on them,” he said.
      Studies have shown that good communication can improve clinical care through better adherence to treatment plans, improved patient and physician satisfaction, better data gathering, and more appropriate medical decisions. Good communication between physician and patient also can reduce the risk of malpractice claims, said Dr. Gullen of the Mayo Clinic, Scottsdale, Ariz.
      The American Academy on Communication in Healthcare ( has divided patient-physician communication into three functions: information gathering, relationship building, and education. The purpose of a good patient interview is to address all these areas.
      Information gathering involves active listening. A University of Rochester (N.Y.) study showed that, on average, doctors interrupt a patient's narrative after only 18 to 23 seconds. Make an effort not to interrupt a patient for at least 1 full minute, suggested Dr. Gullen.
      In primary care, “about a quarter of patients think we didn't talk about, [solve], or address the problem for which they saw us. For subspecialists, it's about the same: Maybe a third of the patients think the subspecialists either didn't address the problem or didn't explain the recommendations very well,” he said.
      Patients present with an average of three to five complaints, and the first one they recount is usually not their main concern, so don't spend the entire visit on that, he cautioned. Instead, after patients tell you their first complaint, ask, “Is there anything else?” To prevent making patients feel as if what they just told you is unimportant, you can add, “I'm really concerned. I just want to see if you brought anything else with you.”
      Eliciting as much information as you can at the outset helps decrease “oh, by the way” or “doorknob” complaints that patients volunteer as a visit is ending, he added. And even if you get a laundry list of complaints, you may realize that several items are related and can be dealt with at one time.
      If there are too many issues to deal with in one day, Dr. Gullen suggested being transparent and saying something like, “I want to give you good care, so let's focus on a few things.” Set a clear limit as to what can be accomplished in one visit, negotiate with the patient to set the agenda, and make a plan for another visit if necessary.
      Active, open-ended listening can be hard work, but patients are often surprised and grateful to be listened to. When they are done speaking, summarize what they said so that they feel heard and can correct you if you misunderstood something. Then you can bring them back to what you want to focus on, he said.
      Relationship building is another important goal of physician-patient communication. Patients tend to judge the quality of care on the basis of the quality of the relationship, not the technical skills of the physician (Ann. Intern. Med. 2006;144:672).
      Dr. Gullen suggested that to improve your relationship-building skills and establish the patient's trust, think of the acronym PEARLS:
      Partnership. This involves working with the patient to define the issues and create a treatment plan.
      Empathy. Understanding can be communicated to the patient through remarks such as, “That sounds hard,” or “You look upset.”
      Apology/acknowledgment. Show concern for the patient through comments like, “I'm sorry I'm running late today” or “I wish things were different.”
      Respect. Show appreciation for the patient's behaviors by saying things like, “You have obviously researched this problem quite well” or “You have obviously worked hard on this.”
      Legitimation. Reassure patients that their feelings are appropriate: “Anyone would be confused by this situation.”
      Support. Tell patients that you are there to help them.
      Leanne Sullivan is an associate editor with Elsevier Global Medical News.
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      ‘About a quarter of patients think we didn't talk about, [solve], or address the problem for which they saw us.’ —Dr. Gullen

      LTC Perspective

      AMDA Communications Committee chair Daniel Bluestein, MD, CMD, points out that communication with the family, as well as with the patient, is especially important in long-term care. Many patients are cognitively impaired and family members may serve as decision makers.
      “Before suggesting a plan of care, determine what patients and families already know, fear, and perceive about long-term care, how it differs from the hospital, what its strengths and limits are, and so on,” said Dr. Bluestein. Doing so can prevent unreasonable expectations and surprises that may result in bad feelings or even lawsuits.
      He added, “Leave your preconceptions of what patients and families want—based on sociodemographic factors—at the door. Try to find common ground that can be the basis for establishing a partnership leading to shared goals, better outcomes, and patient and family satisfaction.”