I’ll get right down to business: You care about patient communication because you know what a difference it makes to the care you provide.
The many health care professionals I’ve talked to over the years, like you, care about patient communication. And over time, I have heard some common problems, challenges, and requests when it comes to improving patient communication.
Here are three of them. In the words that the providers themselves used.
I’m offering these as part of my strategy to get you observing what you’re already doing–in this case, your communication–in different ways. This is so you might see opportunities and possibilities that you hadn’t glimpsed before. Without adding one more thing to your day.
“People don’t read!”
This is a common frustration. The physician who uttered this particular phrase certainly sounded exasperated, but she laughed as she said it. She was referring to people who are comfortable with reading, but don’t read everything they’re given in a visit. And she humorously wondered aloud about what else she was supposed to do.
When it comes to reading, it tends to be those of ‘low health literacy’ who get all the attention. However, there are many possible reasons why people might not read the materials they are given, regardless of their comfort with print. Whatever these reasons, your aim is increase the chances that patients will understand something important. And this often accomplished by handing patients something to read.
There are many health activities in which reading plays a part. But there are many that don’t need to include or depend on reading.
And these might even be getting in the way. This JAMA editorial argues that care may be improved by “identifying routines and paperwork that do not contribute to patient care or safety.”
What kinds of reading demands are you putting on patients? In other words, in what cases does something have to be read? When and where does it have to be read?
Take a second look at your policies and procedures. Get clear on what patients do and don’t need to read. See what can be eased or eliminated altogether.
When you’re clear on what positively, absolutely needs to be read:
- Get social
Reading—like literacy, and learning—is a social act. A growing body of research documents how important social activity is to health literacy, and this includes reading.
Find out who your patient talks to most frequently, and/or who in this persons’ life they turn to when they need help with a complex language task (known as literacy sponsors). And encourage their involvement in this reading task.
- Work your multimodality
You know by now that text should be accompanied by images and broken up into small paragraphs. Everyone finds this more manageable and memorable.
Many of you tell me that you use or create graphics or simple drawings to explain concepts, which can be handy for patients to take home and share. Sometimes heuristics help. I often appreciate some visuals (such as flowcharts) to remind me of complex information I’ve heard before.
- Build on what they are already reading
If patients use their smartphone to text friends and family, can they text for information or support for the action you want them to undertake? If they read social media, are there reputable sources they could visit on these same social channels?
Your goal here is not to teach people how to read, but to use and build on what they are already reading, and who they’re reading with. It just might take some prompting.
“Patients have preconceived notions and so many misconceptions”
This quote was from a staff member at a dental clinic. I have heard the issue of patient misconceptions or expectations raised many times.
Misconceptions can slow down progress, add to everyone’s frustration, and make it harder to build relationships. Researchers are finding that they can have personal health consequences, such as on a patient’s willingness to follow a recommended treatment.
Patients may walk into the encounter with misconceptions about what they’re doing there, what you’re doing there, or what’s going to happen. They may have misconceptions about treatments, or about human anatomy, or about how the health care system works. In the case of the dental clinic, patients often had misconceptions about who would be treating them, how long it would take, and how much it would cost.
You sometimes have misconceptions, too.
We all have ideas about how the world works. We learn about the world, how to make sense of it, and how to talk about it, from our experiences and from the people around us. Our understandings of the world – including our inaccurate or inadequate ones – are based on a lifetime of our own experience. And on the collective knowledge and experiences of our communities.
Your patient’s misconceptions are related to assumptions or beliefs that they hold. These assumptions and beliefs make sense to that patient.
As non-sensical as it might seem from an expert perspective, whatever your patient thinks, makes sense for them.
- Unleash your inner Sherlock
Find out how your patient’s misconception makes sense to them. Ask yourself this question (I’ve adapted it from Gee’s Discourse Analysis):
‘What must this person believe, in order for what they are doing and saying to make sense?’
This core question will give you your first step to connecting what you know to what the patient knows and believes. As a 2014 study on diabetes misconceptions concluded, “It is imperative for physicians to understand myths and misconceptions in a particular community about a disease to improve patient care.”
Correct or not, patients’ current understandings of the issue at hand will shape how they learn from you. So use their misconceptions as a guide their current thinking. Start where they are—not where you are–and build that bridge to where you’re both going. Because effective education links the known to the unknown.
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“I don’t know how to talk to this patient because…”
This is a phrase I have heard many times. It ends in different ways:
- I have so little in common with them.
- I’m afraid I might be insulting them.
- I don’t know how to talk with someone who believes/doesn’t believe…
- I don’t want to make assumptions.
The practitioners I talked to all want to be able to speak clearly and convincingly to any patient. Even and especially when there are significant cultural differences.
Now, culture and language are about as large and complex issues as you can get. And here they are, intersecting with another enormous, complex issue: health. Let’s all take a deep breath.
Language is a social construct, and use of language a social act. At the most basic level, we use language to be understood and to understand each other. In the patient encounter, the cultural background and world view of both the provider and the patient come into play.
The differences between you and your patient are important. But I think there’s a fine distinction between focusing on the gap and focusing on bridging the gap.
It can be tempting to linger, for instance, on all the information patients are not giving you, or on all the ways you’re not getting through.
You want to create the conditions where everyone has the opportunity to reach their full health potential. So here are two things to try:
- Flip the teach-back on its head
Use your patient’s words back to them. This can be quite powerful when you want to make a point. “You said ‘x’ earlier. I want to show you how that’s connected to y.”
- Take a different look
It can feel hard to connect with someone when we don’t feel we have much in common. But sometimes these differences loom so large in our imaginations that they seem impassable. So try to take a different look at the situation (and what it’s doing to your communication confidence) with these questions:
- How might I respond differently in this moment if this person looked and sounded like me?
- Would I respond in this way if this person reminded me of a beloved family member?
- How would I respond if this person was one of my favorite celebrities?
This isn’t only about obstacles to patient communication; it’s about all your communication. With any patient. Even with your colleagues!
