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Say What?

November 11, 2022

Mid-November 2022

Joseph R. Mikhael, MD, MEd

Joseph R. Mikhael, MD, MEd
Professor at the Translational Genomics Research Institute (TGen) with City of Hope Cancer Center in Phoenix, Arizona, and Chief Medical Officer at the International Myeloma Foundation in Studio City, California.

 

 

As I write my last editorial for ASH Clinical News, I cannot help but return to a key theme of my career: communication. As I previously noted in my “Two Ears, One Mouth” editorial, communicating with patients is a critical aspect of our work as health care providers – it is both an art and a science. And as with all art and sciences, hematology has undergone a tremendous evolution, and it is our responsibility to see ourselves as not just conduits of information but the genuine human connection to patients and their care partners.

I simply love that connection and have devoted much of my career to understanding it, improving it, and encouraging it in others. The “right” thing to say may not always be instinctive to us, so approaching this topic with humility is suggested. Let me share with you, in Dr. Joe listicle fashion, my top 10 tips for communication with patients.

  1. Use strategy, not script. Instead of a predefined text, develop a strategy for talking to patients by assessing their understanding and response and adjusting accordingly. No two patients are the same, so don’t give all patients a prepared medical soliloquy.
  2. Be aware of control issues. The whole medical system is designed to give us control. Patients come to us (and often wait) in an unfamiliar setting, and it can be very daunting for them. Try to promote balance by being welcoming, sitting in a similarly sized chair to the one the patient sits in, and empowering the patient to have a voice in the discussion.
  3. Pay attention to nonverbal communication. Nonverbal communication is huge. In the words of Peter F. Drucker, “The most important thing in communication is to hear what isn’t being said.” Monitor the patient’s body language (and yours), use physical touch genuinely and appropriately, and recognize the discordance between what may be said versus what is intended.
  4. You are the messenger, not the message. Align yourself with the patient by divorcing yourself from test results, good or bad. For example, by saying, “The blood work shows relapse,” you make the results the villain, not you as the messenger. That way, you can partner with the patient against the disease – it also helps if you are next to them viewing the “enemy” together instead of you being the source of the bad news.
  5. Time communicating is time saved. Many argue they simply do not have time in a busy clinical setting to fully communicate, but valuable and intentional communication will ultimately save time as it addresses the patient’s true concerns, builds trust, and reduces confusion. Don’t let unanswered questions fester and stall future visits.
  6. Speak the same language. Arguably the greatest disconnect between physicians and patients is because of our tendency to use medical jargon. Make it a personal challenge to convert complicated concepts into understandable language for the lay public. It is our privilege to do that. And if you are working with an interpreter, have them sit where they can be heard but not seen by the patient, so the patient converses with you.
  7. Practice culturally sensitive care. More than ever we have become aware of massive health inequities, and much of these can be attributed to not providing a culturally appropriate environment in the clinic and hospital. Although this is a complex issue, in some ways it is also simple. Listen to and care about your patient’s circumstances, background, beliefs, and desires. We can all do better.
  8. Remember the eye-line gradient. In Patch Adams fashion, ensure your eyes are at the level of your patient’s eyes. That means kneeling, sitting down, or adjusting in another way to ensure the patient is not looked down upon. I completely believe in this. Towering over patients, especially as a circle of providers around the patient’s bed, is very intimidating to them and constitutes poor communication practice.
  9. Value the empathetic response. This is a process of identifying the emotions a patient expresses – for example, if a patient cries, the worst thing you can do is ignore it – and reacting in a way consistent with that emotion, such as by saying, “I see the results of the lab test have upset you.” This is a skill, as we cannot feel what patients feel or even have to agree with their emotions to be empathetic.
  10. Consider the context. Do your utmost to ensure the patient is the center of the interaction. Set up the space properly, remove distractions, and please don’t stare at a computer the whole time. (Patients love when we review their charts, but not while we are simultaneously talking to them.) Even for shorter visits, this will optimize the time available.

Hopefully these strategies will help you learn what to say and what not to say – and in the process, I trust our patients will be reminded that their health care is about them. Not us.

Joseph Mikhael, MD, MEd
Associate Editor


The content of the Editor’s Corner is the opinion of the author and does not represent the official position of the American Society of Hematology unless so stated.

Have a comment about this editorial? Let us know what you think; we welcome your feedback. Email the editor your response, along with your full name and professional affiliation if you’d like us to consider publishing it, at ACNEditor@hematology.org

 

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