Physician Patient Communication

All professions need good communication skills. Obviously in healthcare the ability to communicate with patients should rank high in a physician’s list of talents. These days that interaction occurs in a number of ways: face-to-face, direct telephone contact or though a staff member, via emails, patient portals, or even texting. Because the communication is in the arena of medicine, the protection of an individual’s health information is paramount. Enter HIPAA, which is a federally mandated program to ensure patient confidentiality.

The face-to-face form of interaction is the most rewarding because multiple senses are used in the process. First, I listen to the words while hearing the tenor of a patient’s voice; a few octaves higher with anger or fear, deep and gnarly from years of smoking, “push” of speech in an anxious or grandiose individual, or an accent that might be heavy enough for me to wonder if there is a cultural or comprehension problem. Sight gives me other cues; body language–crossed arms, angry face, tearful, an open posture, a resigned facial expression, stiff limbs or back. Sometimes my sight reveals more concrete things–bizarre tattoos, picked at sores, expensive accessories, worn and torn clothing. My nose may be assailed by the scent of the smoker, too much perfume, not enough soap, musty clothing or pleasant shampoo–all of that speaks to me. Finally touch–dry and peeling skin, a mass somewhere it shouldn’t be whose texture may speak to me of reassurance or of terror.

The opposite must be true as well. We speak volumes to our patients without opening our mouths, or despite opening them. The tenor of our voices may be patronizing, authoritative or uncertain. Our faces and body language reveal our thoughts with a roll of the eye, crossed arms, or open facies. We can look professional or casual. Smell can be important–what asthmatic wants to see a physician whose aftershave or perfume is overwhelming? Perhaps touch is the most expressive. Early on I learned that even when I don’t need to, patients expect to have a “laying on of hands” in some fashion. They may trust you less if you haven’t at least looked in an ear or listened to a heart.

The hardest communication for me is remembering to finish with eye contact and a plan: “We’ll contact you with the lab results”, “I will have our referral clerk Megan call you” or just “Have a great holiday” instead of rushing out to see the next patient. But the best visits include a hand shake or on a good day, a hug.

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11 thoughts on “Physician Patient Communication

  1. Nice piece. My only quibble is there is perhaps an unintended dismissive tone in the statement “Early on I learned that even when I don’t need to, patients expect to have a “laying on of hands” in some fashion. They may trust you less if you haven’t at least looked in an ear or listened to a heart.” It seems to me that laying on of hands should be about diagnosis not some ‘trick’ to gain a patient’s trust. In Lisa Sanders great book “Every Patient Tells a Story,” about medicine’s current unwavering faith in technology, she quotes Hippocrates: “It is the business of the physician to know in the first place, things which are
    to be perceived by the sight, touch, hearing, the nose, the tongue, and the understanding.” He seems to imply that trust comes later, or maybe is even irrelevant.

  2. Not to order more tests on a dead horse, but the blog post you sent me to made my blood run cold. This guy either was having a bad day, or hates his job. To make a statement like: “And true love and empathy have been replaced by fear of a tort system that accuses and a government.” Is truly chilling. Our better angel traits–love, empathy,kindness,humility–can never be stolen, only surrendered. And if this guy has given them all up, I would certainly never want him touching me.

  3. He was waxing poetic and using hyperbole to make his point but in a healthcare system close to 50% of physicians are showing significant signs of burnout. I see that in my colleagues at that percentage. I assure you, the “better angel traits” are beaten down on a regular basis.

  4. If I hadn’t run into Barry at the hardware store, I would leave this alone (and I’m not sure why this entry always comes up as my default.) But you guys should realize that as our implementation of capitalism becomes more and more Darwinian, more and more people are going to be in a state of “burnout.” You must see it in your practice because it’s bound to affect people’s health when they work 2 jobs with 2 kids and no father. If you are envied, it’s because you have the same burnout but a lot more resources behind you (not that you don’t deserve them.) If the woman who cleans our house gets sick or has car trouble, she’s basically f*cked. That’s not the case for you or I. So few people, and probably less than 5% of our elected officials understand anything about living close to the edge, where a health problem, a car problem, a legal problem, any problem, puts them in an untenable situation, no matter how hard they work or how much they want to work hard. Dr’s don’t get the love because most people think “whoa, you don’t know burnout girlfriend.” Blame Barry for this shade.

    • I completely agree. And I love blaming Barry, he’s got that Jewish “victim” thing going. But seriously, I agree that I have more resources, my only question is: Do you want a burned out doctor taking care of you?

  5. I want a semi-burned out doctor before I want a guy who feels like he has surrenderd “love and empathy: to the government and tort law. I’ll take the strong but overwhelmed before the weak and cowering. Take all yr social media but like our bookstore customers, somehow they want human connection, touch if you will, before anonymous digital connection. We are hostage to our primate brain, after all, and there is no greater joy than picking the nits out of our beloved’s fur.

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