Effective patient-physician communication: the cornerstone of quality care

Communication between physician and patient is a given. Without it, there can be no diagnosis, no treatment and most probably no recovery. But what should that communication entail to build a meaningful and trustworthy therapeutic doctor-patient relationship, particularly at a time when the digital revolution is completely changing the way healthcare providers and patients are interacting with each other?

Research and opinion articles about the topic are aplenty. Ask Dr Google and he will bring up countless articles with titles such as “How can Doctors Improve their Communication Skills in healthcare?”, “The importance of Doctor-Patient Communication” and “Good Communication between Doctor-Patient Improves Health Outcome”.

However, my encounters with healthcare professionals (HCPs) through the years have made me wonder if these articles are actually read. I’ve met doctors who hardly make eye contact, doctors who interrupt mid-first sentence, doctors who dish out scripts without giving a proper diagnosis or checking about other medications or possible side-effects, doctors who don’t get back with test results, and the list goes on.

Strangely, it didn’t bother me because my ailments were never too serious and I could navigate my way between the healthcare professional’s mumblings, the infamous Dr Google and the pharmacist.

It was an unexpected breast cancer diagnosis that forced me into realising the importance of effective, understandable and empathetic communication between members of the treating team and the patient. How it could mitigate the perception of a potentially life-threatening diagnosis and turn it into a strangely positive learning experience, making acceptance of the diagnosis, the side-effects of treatment and adherence to therapy so much easier. But it was not just the face-to-face communication that I had with healthcare professionals that eased my journey through diagnosis, surgery and therapy. It was also what happened in between that contributed to my unfaltering belief that “we” could beat this thing.

These include comprehensive reading material emailed to me to support and expand the information provided during face-to-face consultations; an open communication line on email and sms with members of the treating team with prompt answers provided to my queries; regular reminders of appointments; timeous alerts when appointments were running late and even a virtual after-hours meeting with my oncologist after an appointment had to be cancelled due to an emergency on her side.

Impact of poor communication

Establishing the type of meaningful and trustworthy relationship I had with my treatment team is not always easy for healthcare professionals. Too many, patients, too little time; dealing with difficult or anxious patients; a heavy administrative burden; fear of litigation; unrealistic patient expectations and a lack of focus on communication skills at medical school are just some of the reasons why communication lines between physician and patients are often disrupted or completely cut, leading to patient dissatisfaction and lack of compliance, worse clinical outcomes and, in a worst-case scenario, malpractice litigation.

Statistics cited during a recent webinar on medication errors showed that poor communication between doctors and patients as well as between prescribing doctors and other members of the healthcare team (nurses, pharmacists, etc) was responsible for more than half of these mistakes, often leading to adverse outcomes and even death. Research on the reasons for medical malpractice claims has found mis- or poor communication by doctors and other medical staff to be the leading causes of why patients decide to sue.

Furthermore, the perception of inadequate doctor-patient communication can cause untold damage to a physician’s practice and reputation including dissatisfied patients who do not return and negative feedback that may impact the physician’s ability to obtain future patients.

Literature on successful or failed patient-physician interaction highlights patients’ perception of the encounter, the level of physicians’ empathy and their communication style, tone of voice and body language or non-verbal communication as the main contributing factors.

The impact of technology

The days of patients being intimidated by the medical knowledge of their treating healthcare professional, just accepting the diagnosis and treatment plan are long over. Even though Dr Google is often wrong or misunderstood, he has given patients the power and elementary knowledge to ask questions and demand answers.

On top of that, the Covid-19 pandemic has caused a revolution in the traditionally accepted face-to-face patient-physician communication. With patients physically separated from doctors, telemedicine technology had to be rapidly improved to facilitate consultations, leading to many ethical questions, but also opening a myriad of opportunities to improve and expand communication channels.

In an opinion piece published in the BMJ by Pallavi Bradshaw from the MPS, the question is asked if the pandemic has changed the doctor-patient relationship forever. ¹ The answer is ‘yes’ writes Bradshaw but warns that the risks of miscommunication and misdiagnosis are heightened if medical examination is limited.

However, she explains, these risks can be “mitigated to some degree by altering our consultation style—listening actively, checking back information and warmth of tone. Cost, convenience, and risk mean telemedicine will remain a fundamental tool, but potentially to the detriment of the connection we have with patients.”

Preliminary research has shown that particularly younger patients prefer technologically savvy healthcare providers who can communicate with them through the communication channels they are using in their daily lives such as texting and video - and voice calls. Automated text messages such as reminders of appointments and preventative and pre-appointment requirements such as fasting have been shown to be highly effective while apps that allow patients to view their medical history empower them to become active participants in their care.

Recently introduced cloud-based patient relationship management (PRM) systems offer new ways to keep the lines of communication between healthcare providers and patients open. The technology optimises and supports the entire patient care journey and enables the flow of information within healthcare systems and between providers and patients, making it easier to initiate, monitor and document the communication taking place.

Revisiting communication skills 

A renewed focus on the basics of effective patient-physician communication whether it takes place face-to-face or virtually, is therefore needed to address possible misunderstanding and communication issues.

An article published in the Journal of Clinical and Diagnostic Research in 2015² describes some of the main barriers to good healthcare communication as ‘a lack of insight due to inadequate knowledge and training in communication, doctors often not understanding the importance of keeping patients adequately informed and failure to pay attention to non-verbal components of the communication.” In addition, stress, tiredness and lack of time, particularly in an overburdened health setting, could contribute to communication failures.

Advice on good communication in healthcare by the authors includes:

• Listen patiently and pay attention to both the verbal and non-verbal components of the patient’s communication. Physicians should also be aware of their own non-verbal clues like language, gestures, eye contact and tone of voice. Nonverbal communication is often considered to be less important, but research has shown that it does have an impact on patient satisfaction,
• Show interest in what the patient is saying with your mannerism, body language and active involvement like leaning towards the patient.
• Be careful not to interrupt when the patient is expressing something.
• Always provide information on what the patient wants to know and promptly respond to the patient’s reaction. Supporting information in the form of articles, brochures and Frequently Asked Questions should also be provided especially when serious and chronic diseases are diagnosed.
• Discuss nature, course and prognosis (both short-term and long-term) of the disease, treatment options available and necessity of the investigations.
• Discuss the necessity and feasibility of expensive investigations and drugs and their effect on main course and outcome of disease.
• Involve the patient in the decision-making. The treatment plan must conform to the patient’s understanding, beliefs, cultural values and concerns.
• Put additional efforts into motivating patients regarding adherence to lifestyle modifications.
• Don’t use medical jargon. Always explain in simple language.

Conclusion

The rapid digital transformation in healthcare has stimulated huge debates on the possible risks and ethical concerns, but there is no turning back. Healthcare professionals will have to adapt and learn to mitigate the possible risks of digital communication with their patients, ensuring that they stick to the traditional principles of empathy, truthfulness and respect to gather the right information in enabling accurate diagnosis and treatment, leading to quality care and good outcomes.

References:

1. Bradshaw P. Has the covid-19 pandemic changed the doctor-patient relationship forever? https://blogs.bmj.com/bmj/2020/06/08/has-the-covid-19-pandemic-changed-the-doctor-patient-relationship-forever/
2. Ranjan P, et al. How Can Doctors Improve their Communication Skills. J Clin Diagn Res. Published March 2015.  7860/JCDR/2015/12072.5712