How do you ensure that your patients understand what you are trying to communicate?
Good communication is an important part of the healing process. Effective doctor-patient communication has research-proven benefits: Patients are more likely to adhere to treatment and have better outcomes, they express greater satisfaction with their treatment, and they are less likely to file malpractice suits. Show
Interpersonal communication skills are considered so important that they are a core competency identified by the Accreditation Council on Graduate Medical Education and the American Board of Medical Specialties. Learning — and using — effective communication techniques may help you build more satisfying relationships with older patients and become even more skilled at managing their care. Effective communication has practical benefits. It can:
Use proper form of addressEstablish respect right away by using formal language. As one patient said, "Don't call me Edna, and I won't call you Sonny." Use Mr., Mrs., Ms., and so on. Or, you might ask your patient about preferred forms of address and how she or he would like to address you. Avoid using familiar terms, like "dear" and "hon," which tend to sound patronizing. Be sure to talk to your staff about the importance of being respectful to all your patients, especially those who are older and might be used to more formal terms of address. Make older patients comfortableAsk staff to make sure patients have a comfortable seat in the waiting room and help with filling out forms if necessary. Be aware that older patients may need to be escorted to and from exam rooms, offices, restrooms, and the waiting area. Staff should check on them often if they have a long wait in the exam room. Take a few moments to establish rapportIntroduce yourself clearly and do not speak too quickly. Show from the start that you accept the patient and want to hear his or her concerns. If you are in a hospital setting, remember to explain your role or refresh the patient’s memory of it. In the exam room, greet everyone and apologize for any delays. With new patients, try a few comments to promote rapport: "Are you from this area?" or "Do you have family nearby?" With returning patients, friendly questions about their families or activities can relieve stress. Try not to rushOlder people may have trouble following rapid-fire questioning or torrents of information. By speaking more slowly, you will give them time to process what is being asked or said. If you tend to speak quickly, especially if your accent is different from what your patients are used to hearing, try to slow down. This gives them time to take in and better understand what you are saying. Avoid hurrying older patients. Time spent discussing concerns will allow you to gather important information and may lead to improved cooperation and treatment adherence. Feeling rushed leads people to believe they are not being heard or understood. Be aware of the patient's own tendency to minimize complaints or to worry that he or she is taking too much of your time. If time is an issue, you might suggest that your patients prepare a list of their health concerns in advance of their appointments. That way they are prepared and you have a sense of everything they’d like to cover during your time together. The National Institute on Aging has information on doctor-patient communication for older adults. Avoid interruptingOne study found that doctors, on average, interrupt patients within the first 18 seconds of the initial interview. Once interrupted, a patient is less likely to reveal all of his or her concerns. This means finding out what you need to know may require another visit or some follow-up phone calls. Use active listening skillsFace the patient, maintain eye contact, and when he or she is talking, use frequent, brief responses, such as "okay," "I see," and "uh-huh." Active listening keeps the discussion focused and lets patients know you understand their concerns. Demonstrate empathyWatch for opportunities to respond to patients' emotions, using phrases such as "That sounds difficult," or "I'm sorry you're facing this problem; I think we can work on it together." Studies show that clinical empathy can be learned and practiced and that it adds less than a minute to the patient interview. It also has rewards in terms of patient satisfaction, understanding, and adherence to treatment. Avoid medical jargonTry not to assume that patients know medical terminology or a lot about their disease. Introduce necessary information by first asking patients what they know about their condition and building on that. Although some terms seem commonplace—MRIs, CT scans, stress tests, and so on—some older patients may be unfamiliar with what each test really is. Check often to be sure that your patient understands what you are saying. You might ask the patient to repeat back the diagnosis or care plan in his or her own words—this can help with recall, as well. You may want to spell or write down diagnoses or important terms to remember. Be careful about languageSome words may have different meanings to older patients than to you or your peers. Words may also have different connotations based on cultural or ethnic background. For example, the word "dementia" may connote insanity, and the word "cancer" may be considered a death sentence. Although you cannot anticipate every generational and cultural/ethnic difference in language use, being aware of the possibility may help you to communicate more clearly. Use simple, common language, and ask if clarification is needed. Offer to repeat or reword the information: "I know this is complex. I'll do my best to explain, but let me know if you have any questions or just want me to go over it again." Low literacy or inability to read also may be a problem. Reading materials written at an easy reading level can help. Write down take-away pointsIt can often be difficult for patients to remember everything discussed during an appointment about their condition and care. Older adults can especially benefit from having written notes to refer back to that summarize major points from the visit. Try to make these notes simple and clear, avoiding ambiguous and complicated language. For example, you might write, "Drink at least one 6-oz glass of water every two hours" instead of "Increase fluids." Ensure an understanding of the health informationConclude the visit by making sure the patient understands:
One way to do this is the "teach-back method"—ask patients to say what they understand from the visit. Also, ask about any potential issues that might keep the patient from carrying out the treatment plan. Compensating for hearing deficitsAge-related hearing loss is common. About one quarter of people between the ages of 65 and 75, and half of those over the age of 75 have disabling hearing loss. Here are a few tips to make it easier to communicate with a person who has lost some hearing:
Compensating for visual deficitsVisual disorders become more common as people age. Here are some things you can do to help manage the difficulties caused by visual deficits:
For more information about effective communicationThis content is provided by the NIH National Institute on Aging (NIA). NIA scientists and other experts review this content to ensure it is accurate and up to date. Content reviewed: May 17, 2017 How would you learn to communicate in different ways to ensure that the patient understands you?Introduce yourself and explain your role in your patient's care. Review their medical record and ask basic get-to-know-you questions. Establish a rapport. Make eye contact when appropriate and help your patient feel comfortable with you.
What ways can you confirm a patients understanding?Teach-back steps:
I assess my patients' understanding by asking them to explain the concept in their own words. I clarify anything my patients did not understand and reassess their understanding. If my patients still do not understand, I find a new way to explain the concept.
What communication methods are used to ensure we communicate effectively with patients?Effective patient-clinician communication involves two-way communication (spoken, written and non-verbal) that engages patients in decision making and care planning.
What techniques can be used to improve patient understanding?Metaphors, analogies, music and stories are all communication methods that can be implemented to help patients understand and relate to health issues, Osborne added. But the most important piece of the communication puzzle is keeping language simple and concise.
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