When you’re communicating with patients, or anyone, contextual factors have a huge impact on the quality of that communication. My guest today is Dr. Nkemdilim Ezeife. Dr. Ezeife is an internal medicine physician who’s focused on what he calls reducing communicative friction. He shares how he recognizes and manages some of the contextual factors that impact patient communication and the therapeutic relationship.
Hi, everybody. This is 10 Minutes to Better Patient Communication from Health Communication Partners. Since 2017, we’ve been giving you inspiration and strategies to improve engagement, experience, and satisfaction. I’m Dr. Anne Marie Liebel, a researcher, consultant, and educator specializing in communication and education. This podcast makes space to dig into what it’s easy to take for granted about communication in our professional lives, especially in healthcare and public health, but increasingly across sectors because communication touches everything. We’re here to learn and get inspired, but most importantly, make the difference we got into our jobs to make. I help organizations act with clarity and confidence in complex, high-stakes situations. I’m currently booking consulting clients. You can work with me. Reach me on LinkedIn, on Instagram at Health Communication Partners, or at healthcommunicationpartners.com.
I love having guests on the show. And I’m so grateful to the many people over the years who’ve been so generous with their time and their willingness to reflect on their work out loud and allow us all to listen in. And I think when we hear narratives, these stories of practice, they probably are landing differently on each of us. There’s different things that we could take away from it, depending on our context, depending on where we’re at. But one constant, I think, is that my guests’ taking the time to stop and think aloud shows us what it could sound like and feel like for each of us to do the same.
So there’s that kind of permission-giving there, for us to stop and articulate to ourselves, possibly to someone else, the kinds of thinking behind the decisions that we’re constantly making in our professional practice that have to do with communication, conversations, educating, sometimes writing, recording, reading, production, performance, publication. People have talked about all of those things on this show. So if there is an issue or problem in patient communication or patient education you’re facing, I invite you to send it in. Again, reach me on LinkedIn or on Instagram at health communication partners or at healthcommunicationpartners.com.
Dr. Nkemdilim Ezeife is my next guest. And he’s currently navigating complexities in patient communication, like all of my guests are, and taking the time to show us how he’s doing that right now, and where he sees things going for him as a communicator. Maybe this will get the wheels turning for you, thinking of something in your context. If it does, I’d love to hear about it. Here’s Dr. Ezeife.
Today I’m live via Zoom talking with Dr. Nkemdilim Ezeife. Dr. Ezeife is an internal medicine physician in the greater Philadelphia area. Dr. Ezeife, welcome to the show.
Hello there, Anne Marie. It’s a pleasure to be on here.
So, Dr. Ezeife, I’m going to go ahead and jump right in. What is a problem or issue that you are facing in patient communication?
Okay, so you might not know, everyone, I work in the state hospital system in the area, which involves taking care of some patients with significant mental health issues, that are incarcerated often in a bid to help improve their mental health so that they can defend themselves against some legal proceedings or charges that they may have to face in the court. Sometimes their mental health gets in the way of this. So with that said, a lot of these patients are often coming to me with significant severe mental illness that is active at the time of my medical assessments. So oftentimes, patients like this can sometimes not be fully engaged in reality-based communication, for example. Some of them may react to internal stimuli. Some of them may have fixed delusions or other psychotic features that might inhibit their ability to have a straightforward, coherent conversation. So with that in mind, my issue is obviously trying to communicate with them in a way that endears me to them and also enable me to obtain clinically relevant and useful information at the same time, while making sure not to offend their sensibilities, which may be tricky, especially if they’re mentally ill at the time of their assessment.
Right. And that’s where I’m so eager to hear about how. How are you approaching this issue? How are you approaching this specific set of challenges?
Yeah, it’s quite a tricky issue. There’s a few ways I’ve figured out how to do this over my time working here. One thing I did realize is I can’t really stay on the typical like script for a clinical encounter, which would involve me sort of moving through a series of questions, like bam, bam, bam. What I found is that sometimes also that correcting these patients, if they say something that seems off kilter or it’s technically, factually incorrect, it may not be the right move because sometimes they can get quick to be offended if my communication doesn’t really line up with their particular mindset. So other things that present an issue as far as that goes, is trying to figure out what kind of prejudices or whatever beliefs that the patients have. Sometimes that stuff can sometimes inhibit a good clinical acumen or rapport between these patients and I. I try to use plain language for the most part, and try not to get too like wordy with medical terminology because I can’t assume that the educational level, or that the mental level, of these patients is going to be particularly in line with what mine is, for example.
Sure. And I mean, there’s just there’s so much there that you’re talking about that I think listeners will understand is important to do in anyone’s care. So what are you learning from approaching communication with patients in this way?
A lot of patience, I’ll tell you that much. But as far as the specific things I’ve learned, I’ve learned that you can’t stay on the script when
you’re trying to talk to people that are typically dealing with severe, untreated, acute mental illness, first and foremost. So sometimes that requires adjusting my approach to interviewing them. I try to sort of like listen and see how they tend to communicate. Sometimes some of them can’t even communicate in a reality-based manner. Some patients, for example, might be reacting to internal stimuli at the time I talk to them. Sometimes I let that go on for a little bit and try to steer them back into the conversation. That by itself is a tricky process sometimes, that does require patience. Another thing that I’ve learned over the time trying to do these kinds of things I just described. is that it’s important for me to not try to push my agenda too hard. Because if I tried to do that and stick to a script, for example, sometimes some patients can pick up on that, and then you lose your trust with them. Sometimes your trust with them is sometimes based on buying into, I guess, whether it be their delusions or their mental illness, just that tiny little bit to sort of ingratiate them towards you, so that you can actually create a proper dialogue, and allow them to talk to maybe get some information you might not have otherwise heard from them.
So what are some of the next steps for you in patient communication and thinking about how you are interacting with this very specific patient population?
Yeah, so this is different than my previous role where I worked in a typical clinical inpatient hospital setting. So there’s a lot to talk about there. So the main thing is the next steps to trying to deal with this population. compared to where I came from would be trying to basically minimize communicative friction between the patients and myself. When I say “communicative friction,” obviously there’s many barriers that are just naturally inherent, whether they be socioeconomic, the mental status between me versus the patient, the environment that we are both in during the encounter is another good example of that. So, trying to meet them on whatever levels they can. Obviously, there’s limits based on the confines. Obviously, I’m seeing them inside of this facility, which is still a correctional facility for the most part. So the main ways that to decrease communicative friction really come down to doing things like, for example, trying to let them talk for a little bit to sort of see what they’re about. Trying to ask them non-demanding questions, trying to make them more a participant in their care. Try to ask them things. And also reassure them that you’re not trying to force something on them. So I found those are some of the strategies that I’ve been working into improving. I don’t want them to feel as if they are difficult patients in the course of my encounter with them.
Wow. You said so much there. Dr. Nkemdilim Ezeife, thank you for being on the show.
Anne Marie, it’s been a pleasure.
Again, many thanks to Dr. Nkemdilim Ezeife for taking the time to pause and reflect. And thanks to you for listening in. If you want more ongoing thinking like this, let’s work together. Contact me at healthcommunicationpartners.com. I’m Dr. Anne-Marie Liebel, and this has been 10 Minutes to Better Patient Communication from Health Communication Partners. Audio engineering and music from Joe Liebel. Additional music from Alexis Rounds.
