Effective doctor-patient communication is central to building a therapeutic relationship, which is the heart and art of medicine. Neither a doctor is a robot, nor is a patient an object! Most of the time adequate communication is missing and that leads to several problems. Patients’ expectations are high and unrealistic. He feels that once he is before the doctor, he need not narrate his pains and problems in some detail and it is doctors’ duty to ‘feel the pulse’ and guess everything. Often a patient will enter ‘my chamber’ and just point towards his eyes, even after a question is put ‘what is your complaint or what eye trouble brings you here’. He just smiles away the questions. More often than not he does not bring the old medical records or even the spectacle that he was using.
It is widely known that diagnosis is revealed in the patient’s history. The basis of a true history is good communication between doctor and patient. The patient may not be looking for a diagnosis, when present before the doctor and search for one under such circumstances is likely to be fruitless, if patient does not co-operate. What if patient remains quiet or irrelevant? To obtain a true, representative account of what is troubling a patient and how it has evolved over time, is not an easy task without patient’s co-operation. While patient avoids history giving and doctor is busy or apathetic, needless investigations and referrals become the rule!
A doctor’s communication and interpersonal skills encompass the ability to gather information in order to facilitate accurate diagnosis, counsel appropriately, give therapeutic instructions, and establish caring relationships with patients. Doctors tend to overestimate their own abilities in communication. A report said that 75% of the orthopedic surgeons surveyed believed that they communicated satisfactorily with their patients, but only 21% of the patients agreed. Good doctor-patient communication has the potential to help regulate patients’ emotions, facilitate comprehension of medical information, and allow for better identification of patients’ needs, perceptions, and expectations. Patients’ agreement with the doctor about the nature of the treatment and need for follow-up is strongly associated with their recovery. Doctors with better communication and interpersonal skills are able to detect problems earlier, can prevent medical crises and expensive intervention, and provide better support to their patients. Medical schools now teach communications skills. Physicians become competent in five key communication skills: (1) listening effectively; (2) eliciting information with leading questions or using effective questioning skills; (3) providing information using effective explanatory skills; (4) counseling and educating patients; and (5) making informed decisions based on patient information and preference. With the advent of digital record keeping, doctors are losing the ability to look patients in the eyes, listen intently to their fears and concerns and provide the support and care that is so necessary for healing. Doctors need to listen more and talk less. When meeting with patients, doctors shouldn’t interrupt or dominate the conversation. Instead, doctors should ask open-ended questions to encourage each patient to describe his or her feelings and concerns about their illness.
Illness robs patients of confidence and issues they once had the freedom to address become things to avoid. What happens for the person who no longer has the confidence to speak up is that minor annoyances grow into perceived problems. Doctors are not mind readers. The success of any person-to-person communication depends on the level of respect between the people involved. Would there be fewer complaints about lack of communication with doctors if patients understood they have a role in making effective communication a two-way process? Patient communication is an important part of doctor’s medical practice. It is always a good practice to ask questions to a patient that cannot be just answered with a simple ‘yes’ or ‘no’. Doctor should always ask questions that will get their patient engaged and open up about their problems, and illness. Patients are nervous and scared about their health condition, or are not in a mental state to comprehend the situation when they visit a clinic. In addition, many patients have trouble understanding the procedures and medical terminology that doctors use. To be sure, check with patient’s body language and expressions. If the patient answers with a nod and looks confused, repeat the instructions. Language is another hurdle in the effective patient communication. To overcome this problem, doctor should speak slowly and clearly especially for patients with language issues to make sure the patient has clearly understood instructions. This increases chances of patient compliance, as they understand the importance of the treatment. Be empathetic towards patient’s condition. Empathetic behavior demonstrates that doctor understands the mental and physical state of the patient. Patients always prefer doctors who understand their state of mind and their dilemmas. Implement Patient Satisfaction Surveys. If a patient is always polite and does not complain in front of doctor, it does not mean that they do not have any problems or issues with the advice. Knowing patient’s experience and general opinion about clinic experience is invaluable information that would always help improve clinical outcome and gain confidence. Avoid Bias. It is human nature to form an opinion about any person, as is said “First impression is the last impression”. However, this should not be the case with doctors. For an efficient practice management, it is always better not to form opinions about any patient and remain unbiased. A biased practice can result in a positive or negative disposition towards a patient, and may affect communication or care towards that particular individual. Providing same level of care and courtesy to each patient can help eliminate biased communication between doctor and patient.