Patient Communication

1. See Also
   1. Emergency Department Patient Satisfaction
   2. Risk Management
   3. Conflict Resolution
   4. Difficult Clinical Encounter
   5. Health Risk Motivational Counseling (Five Rs Technique)
   6. Health Risk Behavior Counseling (Five As Technique)
   7. Chemical Dependency Brief Counseling (FRAMES Technique)
   8. Breaking Bad News
   9. Discussing Terminal Illness (Discussing Death, End-Of-Life Care)
2. Management: Patient-Centered Communication
   1. Bedside Presence
      1. Among our most important healing tools
      2. Make eye contact
      3. Hold a patients hand when appropriate (e.g. fearful patient, elderly, Dementia or Delirium)
      4. Use language appropriate for the patient (e.g. simple language in Dementia)
   2. Understand patient's agenda
      1. Introduce patient, provider, family and others in the room
      2. Welcome new patients
      3. Start with non-medical break-the-ice topics (if time)
      4. Ask open ended question (e.g. "How can I help you today")
      5. Allow patient to speak uninterrupted initially
      6. Ask, is there something else?
      7. Actively listen while the patient is speaking without distracting activities
   3. Understand patient's perspective, psychosocial context
      1. Avoid judging patient's emotions as appropriate or inappropriate
      2. Avoid offering premature reassurance or normalizing patient's concerns (e.g. "common reaction")
      3. Understand patient's expectations from encounter (e.g. work note, reassurance)
      4. Express empathy and concern
      5. See Breaking Bad News
      6. See Discussing Terminal Illness (Discussing Death, End-Of-Life Care)
   4. Shared treatment goals
      1. Discuss treatment options (including no treatment or watchful waiting)
      2. Avoid overwhelming the patient with too much information
   5. References
      1. Hashim (2017) Am Fam Physician 95(1): 29-34 [PubMed]
3. Management: CLAP Mnemonic
   1. Curiosity
      1. Approach conversations with an nonjudgmental attitude, open mind and genuine curiosity
   2. Listen
      1. Actively listen and hear the patients concerns
   3. Aspirations
      1. What does the patient and their family want from the encounter
   4. Personal
      1. Avoid taking conflict personally
4. Management: Maintain good communication with patients and their families
   1. Establish a relationship with patient and families
   2. Listen well
      1. Avoid missing important details due to interruption
      2. Direct the patient to the current history and avoid interrupting for at least the first minute
      3. Gain credibility through reciprocal communication
      4. Listening to a patient's story allows them to unload details and free-up memory to absorb what medical providers say
   3. Apologize for medical errors (with administrative Consultation)
      1. Medical providers should consult with their employers and Risk Management teams prior to disclosure
      2. Some hospitals have full disclosure policies
      3. A majority of states have apology laws
         1. Protect providers and organizations to some extent when they disclose medical errors
   4. Address patient or family dissatisfaction, anger or other negative emotions associated with the visit
      1. See Conflict Resolution (for effective methods including better listening)
      2. See Emergency Department Patient Satisfaction
5. Management: Benevolence correlates with best and most satisfied FP's
   1. Preserve and Enhance people's welfare
   2. Patient Descriptions of "Good" physicians
      1. Helpful
      2. Honest
      3. Forgiving
      4. Loyal
      5. Responsible
6. Management: Shared Decision Making
   1. All decisions regarding patient care should involve input from the patient or their proxy
   2. Shared Decision Making lies on a continuum of paternalistic and informed decision making
      1. Incorporates information exchange, deliberation and choice
   3. Characteristics
      1. Respect for patient values
      2. Integration of care
      3. Communication and Education
      4. Involvement of family or friends
   4. Four criteria of Shared Decision Making
      1. Involves at least two participants (typically provider and patient/proxy)
      2. Both participants share information
      3. Both participants work together to form consensus
      4. Agreement on treatment plan is reached
   5. References
      1. Boyle and Ponce (2018) Crit Dec Emerg Med 32(10): 11
7. References
   1. Swadron and Shoenberger in Herbert (2019) EM:Rap 19(7): 1-2
   2. Henry (2013) Avoid Being Sued, EM Bootcamp, CEME