Training helps doctors connect with patients
Training helps doctors connect with patients
Patient-centered approach can save time
Can doctors learn to be warm, caring, and empathetic? Can a seminar turn them into better listeners?
The answer is a resounding yes, according to research by Debra Roter, DrPH, a professor at the Johns Hopkins School of Public Health in Baltimore and an expert on physician-patient communication.
Roter found that teaching communication skills to physicians improved their ability to detect emotional distress in their patients.1 "We followed them for six months," she says. "The patients of the physicians who were trained showed significant reductions in emotional distress."
Some people are naturally more inclined to make empathetic statements and to verbalize feelings. But there isn't one correct way for a doctor to communicate to show he or she cares about the patient, says Roter.
"Sometimes physicians say, 'I'm not a warm, fuzzy person, I just try to be as conscientious as I can,'" she says. "Patients recognize that. Patients generally want their physicians to be very informative in the biomedical and the psychosocial realm. If you feel your physician is forthcoming and volunteers information, that contributes to a sense of trust."
The American Academy on Physician and Patient in McLean, VA, has outlined some key elements of the physician-patient relationship, including the core values of "respect, empathy, and genuineness in human relationships." The academy offers training programs geared toward both teachers of medical students and residents and clinicians.
"Most physicians feel empathy toward their patients, but not all physicians have the skills to express empathy in a meaningful way," says Jenni Levy, MD, an internist in Allentown, PA, who teaches residents at Lehigh Valley Hospital. "It is possible to teach those skills."
"It's also possible to identify some of the barriers to that and some of the predictable issues that will arise in the physician-patient relationship and help people deal with them," she says.
Power of the patient-centered approach
For Levy, good communication and empathy are just aspects of a patient-centered approach to medicine. That means thinking about illness in the context of the patients' lives and allowing patients to help set the agenda for their visits. "It's been very powerful for me" to take that approach, she says. "It changed the day-to-day way I interacted with patients."
Levy remembers a woman who came to see her about two years ago complaining of fatigue. Although Levy's exam showed no physical cause, Levy posed a question: "What I'm hearing you tell me is that you're really tired, and I don't see any physical reason for that. I'm wondering if there's something that bothering you. What do you think it might be that's causing your fatigue?"
Levy waited patiently for an answer. The woman looked distressed, hesitated, then responded, "I wonder if it's because I was sexually abused as a child. I've never told anyone that. But I wonder if that's what's going on." The patient started to cry.
"It was an incredibly powerful moment to know that she was comfortable enough to say that," recalls Levy. "Once it was out in the open, she was very willing to go into therapy and talk about it. She's not been back in my office complaining about fatigue. When I have seen her, she's doing very well."
Without the patient-centered approach of asking the woman about her own perspective, Levy says she may well have given her a lecture about stress and sent her on her way - only to see her again with that or another problem.
Why being abrupt doesn't pay off
Time pressures may trigger an abrupt attitude among physicians and staff, who don't feel they have time for small talk while other patients are waiting. But Levy contends that a patient-centered approach can save time.
"You get more information more quickly" with open-ended questions, agrees Michael Nathan, MD, an internist with the MGH Health Care Center in Revere, MA. Nathan, a clinical instructor in medicine at Harvard Medical School, tries to get everything on the table in the first two or three minutes of a patient encounter. If a patient mentions shoulder pain, he asks what else is bothering him or her before launching into questions about the shoulder.
Effective communications courses aren't limited to such basic tips, say Levy and Nathan. Training gives physicians a chance to interact and even to role-play.
Robin DiMatteo, PhD, professor of psychology at the University of California-Riverside and long-time researcher of the doctor-patient relationship, developed a program using videotapes of actors portraying different scenarios in medical encounters. The tapes serve as "trigger films" to spark discussion among physicians, who then delve into their own barriers to better communication.
"Every time I do the training, different things come up in the group," she says. "One will focus on the nonverbal cues and facial expressions. Another group will focus on what the physician says; another group will be very savvy about underlying psychological issues."
DiMatteo, who works with the consulting firm Medical Communications Strategies, also occasionally videotapes physicians with patients or in role-playing.
"There's no question that some physicians and some people in every profession are more extroverted, are more people-oriented, than others," she says. "But I don't think a person needs to be super-sociable or the life of the party to be a good communicator."
"I think the basic abilities are in everybody," she says. "We need to start by building that attitude of wanting to connect to patients as people."
Reference
1. Roter D, Hall JA, Barker LR, et al. Improving physicians' interviewing skills and reducing patients' emotional distress: A randomized clinical trial. Arch Intern Med 1995; 155:1,877-1,884.
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