Effective patient communication: How to ensure that your patients are really hearing what you are telling them

Effective patient communication is essential to effective patient care. Patients who fully understand their diagnoses and treatment plans are engaged in their own care, which could lead to better clinical outcomes.

Key Point: Clearly communicating with patients is a cornerstone of successful patient care. You can help patients understand what you are saying to them by using handouts, diagrams, and other educational tools. Asking patients to repeat clinical information back to you in their own words is a good way to gauge their comprehension of the points you are seeking to communicate.

On the other hand, every physician is familiar with the blank look that some patients can get when they are too overwhelmed, confused, or upset to understand what you are telling them. Depending on the importance of the message and the severity of the condition, the results can be disastrous for treatment.

Clearly, when patient communication is successful, the experience is better for both you and your patients.

So how can you make sure that you’re being[s2If !is_user_logged_in()]…

[/s2If][s2If is_user_logged_in()] heard and understood?


“A simple technique is to follow ALPAC: Ask, Listen, Praise, Advise, and Check understanding.”
-Harish K. Pemde, MD, professor of pediatrics, Convenor, Center for Adolescent Health, Lady Hardinge Medical College, Kalawati Saran Children’s Hospital, New Delhi, India


Taking time to teach

Clear communication is an important physician responsibility, says Harish K. Pemde, MD, professor of pediatrics, Convenor, Center for Adolescent Health, Lady Hardinge Medical College, Kalawati Saran Children’s Hospital, New Delhi, India. Doctors often are too rushed to be clear, he says.

“A simple technique is to follow ALPAC: Ask, Listen, Praise, Advise, and Check understanding,” he says, adding that patients will ask questions if physicians create an environment in which they are encouraged to do so.


 “It reminds me that I often overestimate my skills as a communicator—and that I need to slow down and repeat what I’ve said, because sometimes patients can be very selective about what they hear.”
-Aniruddha Malpani, MD, medical director of Malpani Infertility Clinic in Mumbai, India, and author of a physician and patient education blog


Patient engagement

Six principles of effective communication

  1. Prepare patients before an appointment in which medical test results will be delivered. If bad or complex news is being delivered, ask the patient to bring a spouse or supportive friend or family member. Schedule the appointment at a time when you’re not rushed.
  2. Think about the most important points that you want to make and stick with them. Don’t bury the important news in an avalanche of trivial information.
  3. Start with the prognosis, not the diagnosis, and use language that matches the patient’s level of understanding.
  4. Periodically ask the patient to repeat back what you’ve just told him or her to make sure the information is understood.
  5. Use easy-to-understand handouts, props, and diagrams. For additional information, guide patients to authoritative and accurate Web sites, support groups, and other sources.
  6. Make yourself available through follow-up visit(s) or by phone for additional questions and to see how the patient is feeling.

Aniruddha Malpani, MD, is medical director of Malpani Infertility Clinic in Mumbai, India, and author of a physician and patient education blog at http://blog.drmalpani.com/. In vitro fertilization (IVF) is a complicated and emotional subject, and Malpani employs a number of tools to educate patients and make sure that they retain what they’re told. His patient communication tools include a comic book titled The Baby Chase (http://ivfindia.com/baby-chase-comic-new/); an e-learning course (http://www.ivfindia.com/ivf-elearning-course-with-sound/shell.html); and even infertility-themed games (http://ivfindia.com/patience-pays/solitaire_game.htm).
In addition to his high-tech patient communication tools such as blogging and online aids, Malpani knows the importance of face-to-face communication.

“I find using the teach-back technique particularly useful,” he says. “I ask the patient to explain to me what they’ve understood. Often, asking the wife to explain the IVF treatment to the husband in front of me is a great way of ensuring they’ve understood exactly what we are going to do. Listening to their explanation is a very useful learning experience for me. It reminds me that I often overestimate my skills as a communicator—and that I need to slow down and repeat what I’ve said, because sometimes patients can be very selective about what they hear.”

He illustrates his messages with a popup book called Facts of Life, which includes a 3-D model of the reproductive systems.

Like Malpani, Pemde also supplements his instructions with written materials.

Delivering bad news

It’s particularly important to be clear when delivering bad news to a patient, not only because the information is serious, but because the patient is less likely to recall everything.

That was the conclusion of Jesse Jansen, MA, a researcher at the Netherlands Institute for Health Services Research. In a study published in the Journal of Clinical Oncology (November 2008), Jansen reported that, regardless of age, patients receiving a poorer prognosis recalled less than other patients. The study cites a number of possible reasons for this phenomenon, including denial and a desire to avoid bad news in order to maintain a positive spirit.

“In general, patients do not hear much of what is said after bad news is delivered,” Jansen wrote in his paper.

The study also found that the more prognosis information that was provided, the less patients recalled, regardless of the actual prognosis.

“Communicating prognosis requires careful tailoring to individual patient’s preferences for more or less information and balancing the needs for clear information while maintaining hope,” Jansen added.

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