Although my medical school created many opportunities for clinical exposure during the first two years, none of it compared to the immersive experiences that were to follow. Textbooks, PowerPoints, and lectures galore were supplanted by hundreds of patient interactions in my rotation months. Here are four patient communication tips that have served me well, and that I wish I knew from the outset of my rotations.
1. Build rapport with the first question itself. I discovered early on that, more often than not, the prompt, “How’s it going?” got me some variation of the perfunctory “good,” “fine” or “alright” as the response. As a result, my initial question of choice eventually evolved into, “Did you come from home or from work?”
Despite all the training to start patient interactions with open-ended questions, I strongly believe that this is a worthwhile exception. I’ve found that this question helps me quickly build rapport with my patients and learn about the person behind the diagnoses. After all, this question instantly launches us into a discussion about either the patient’s living situation and relationships or about their job and associated stressors. This also makes me privy to information that I may not have otherwise discovered during that encounter without a targeted social history assessment. For instance, in response to this question, a patient I was seeing replied, “from the streets.” As a result, I was able to learn about and help address his homelessness and food insecurity challenges during his visit.
2. Preface the EHR. The EHR can certainly serve as a barrier to patient-provider interactions, and it definitely creates extra logistical hassles for providers. However, I can only imagine the difficulties that the lack of an EHR must have created for medical trainees in generations past, given its utility in long-term disease monitoring and coordination of care. Moreover, since it’s certainly here to stay, presenting it in a positive light to patients encourages them to embrace it as an aid rather than as an obstacle. Early on in each appointment, I like to present it as an efficiency tool: “I’ll be typing while I talk so you won’t need to repeat your answers.” Also, as a thoroughness tool: “It helps me make sure I don’t leave anything out when I’m sharing what you told me with my seniors.” I’ve also found that patients appreciate having the computer screen angled towards them so they can share in the EHR experience as well.
3. Preface the repetition at a teaching hospital. Especially for those being seen at a university-affiliated hospital, the title “patient” really couldn’t be more perfect. Often, patients need to share their story with the medical student, then with the resident, and then once again with the attending, even with thorough presentations to the next senior person prior to each patient interaction. By the third iteration, I’ve heard many an irate patient comment — “I have to explain this again? I already told her everything!” — with one patient even leaving clinic before the attending was able to stop by.
And who can blame them? I’ve found, however, that even just quickly prefacing the flow of the hospital is incredibly useful. As I’m heading out of the room, I typically say something to the effect of, “Just a heads up: My resident/attending will probably ask you some of the same questions that I did, but that’s just to double check my work since I’m the medical student; however, I can assure you, on my part, I’ll tell them everything you shared with me.” In my experience, a notice like this has helped make for a much happier patient by the end of the visit.
4. Is it a child’s medication? Every decade brings us incredible advances in chronic disease management, but patient non-adherence with medication regimens often prevents them from reaching their full potential. Fear of the medication’s side effects or concern for “habit-forming” potential is something cited by many patients I see. The one reassurance strategy that I’ve found works the most consistently and most quickly for me (when applicable) is informing the adult patient if medication is safe enough that it’s routinely used in kids. Of all the reassurances that I share with patients that have a history of non-adherence or medication declination, this is the one point that I’ve found consistently elicits a look of surprise and a comment to the effect of, “Really? I had no idea!” And among other things, it helped me convince one middle-aged patient to finally start using his corticosteroid inhaler and another to finally get his Tdap vaccine.
Subha Mohan is a medical student.
Image credit: Shutterstock.com
