Essential physician communication tips to improve the patient experience [PODCAST]

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“A majority of physicians see between 11 and 20 patients per day, and among all practices, the majority of doctors spend between 17 and 24 minutes with each patient. Assuming a five-day workweek, this translates to more than 900 patient interactions per year and over 1,066 minutes spent communicating with patients. Today, many of these interactions fall short of effective communication so pivotal to building rapport, trust, and loyalty with patients and ultimately driving down the bottom-line results.

While most physicians are compassionate by nature, many struggle to convey that compassion. A recent survey on doctor-patient interactions found that 71% of patients reported they’ve experienced a lack of compassion when speaking with a medical professional, and 73% stated that they always or often feel rushed by their doctor.  These findings highlight the need for medical professionals to develop the ‘soft skills’ – verbal and non-verbal communication techniques, listening skills, and empathy – critical for transforming the patient experience, increasing patient satisfaction, and improving outcomes.”

Anthony Orsini is neonatologist and founder, The Orsini Way. He is the author of It’s All In The Delivery: Improving Healthcare Starting With A Single Conversation.

He shares his story and discusses his KevinMD article, “The case for compassionate communication.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Anthony Orsini. He’s a neonatologist, and he’s the founder of The Orsini Way. He is also the author of It’s All in the Delivery: Improving Health Care Starting with a Single Conversation. Anthony, welcome to the show.

Anthony Orsini: Thanks for having me, Kevin. I’m excited to be here.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and your journey to where you are today?

Anthony Orsini: Sure, I’d love to. I’m a practicing neonatologist here in Orlando. I work at one of the world’s largest and busiest neonatal intensive care units in the world. I trained in Philadelphia, and I’m originally from New Jersey. Really, for the majority of my career, starting when I was a neonatal fellow, I became very fascinated with the way that people communicate, specifically doctors.

I had a really life-changing moment when I was training early on in my fellowship, where I had a very compassionate mentor, someone that I really looked up to, who I witnessed telling a father that his baby had died, very, very abruptly. I go into this in more detail in my book, but it occurred to me at that moment that, although a physician could be very compassionate, and most of them are, and although physicians can be extremely smart, breaking bad news, if you will, or having these difficult conversations with patients and families, was something that, as you know, we’re not trained in, and something that most of us are not good at.

So during my fellowship, and I initially was at NYU Medical Center, I spent 10 years researching, at first, if there is a right and a wrong way to break bad news to patients, to deliver tragic news, and, if there is, is there a possible way of teaching that? I pored through the literature, and at the time, and still, there’s very little literature on that. But then I started interviewing dozens and dozens of family members who had lost their loved ones, and patients who had heard that they had cancer. I started to notice that there was a clear pattern between the physicians who seemed to be thought of as very compassionate when they heard the news and the ones who were thought of as being cold.

So I came up with the Breaking Bad News program, which originally started as improvisational role-playing for physicians, to videotape them, and started a program, an acronym called PROGRAM. So we started training physicians. I gave a few grand rounds. This started in 2011, and the word got out on how effective this teaching was. It kind of spread like wildfire. I started doing a bunch of lectures, and over the course of the last 10 years, I’ve started to realize that the same communication techniques that are necessary to give somebody tragic news are also the same communication techniques that help you in your everyday practice.

You’re a physician. We all know that there are some brilliant physicians and nurses out there who can’t seem to bond with their patients, who are very smart but don’t have great practices. Patient experience is a big deal now, and why is it that some doctors get in the 95th percentile in their patient experience scores and other doctors struggle? It’s not because they’re not good. It’s usually because they have difficulty communicating. So this has evolved now into The Orsini Way, which now trains physicians, nurses, and even business leaders, which I’ll get into later on, on how to communicate and build trusting relationships in a very, very quick period of time. So really, I’m still practicing, but my passion really is how humans in general communicate, but specifically physicians and business leaders.

Kevin Pho: So you contributed the KevinMD article “The case for compassionate communication.” Now, before we get into that, you mentioned that there were two groups of physicians during your literature search, physicians who could and could not communicate compassionately or communicate bad news in an empathetic manner. Now, what are the main differences between those two groups?

Anthony Orsini: I think, in general, the problem with physicians delivering tragic news is, number one, we’re not trained. There are a few OSCEs out there that are helping the medical students, but generally speaking, communication techniques are not something that physicians are trained to do. And we’re also being told some misconceptions about how physicians should really show emotions and how they should feel, and if you’re trying to protect yourself too much, that comes off as being cold, et cetera.

In my training of thousands and thousands of physicians on how to do this, I’ve noticed that about 15 to 20 percent of physicians, no matter how old you are, and it could be interns, are just great communicators. You put them in the videotaped improvisational role-playing, and they knock it out of the park. The kindness and the compassion come through. There’s about 10 or 15 percent, I’ll be honest with you, Kevin, of the doctors I train who are just not understanding why communication in general is important. But the majority of physicians and nurses are generally compassionate people. They just have never learned how to deliver that compassion and show that compassion.

So I teach a lot of verbal and nonverbal techniques. The acronym PROGRAM brings them through this road map of how you should present it. There are a lot of misconceptions out there on how physicians should communicate, and so it’s really a lack of training. When we’re asked to do something as human beings that we’re not comfortable doing, we’re going to just want to get it over with. We’re going to think of it as a task.

Once I’m done training the physicians and nurses, the point I’m trying to make to them is that once they learn, they actually think of having these difficult conversations, whether it’s tragedy, or maybe medical error, or just routine, they think of their communication skills as something they’re proud of, as a skill, just like doing a lumbar puncture or doing a procedure. Whereas before the training, they thought of it as something that they had to get over with as soon as possible.

Kevin Pho: Now, what are some key ways that physicians can communicate compassionately, and what are some misconceptions that you had mentioned?

Anthony Orsini: So I talked about it in the KevinMD article. We tend to think of physicians communicating with patients as informational, that that’s our number one goal. We’ve done surveys, and when you ask physicians what they think the most important goal is that they need to achieve, the most common answer is to provide information. And certainly, that’s important, but the number one goal of any communication is to be able to build a trusting relationship quickly. Without the trust between the patient and the doctor, everything else falls apart. So we know that when you trust your doctor, you’re more likely to take your meds, you’re more likely to follow the therapeutic regimen, and you have better outcomes.

Through certain communication techniques, I can teach you how to build that trusting relationship in a very short period of time. In fact, there’s one study that showed you can build trust between a patient and a doctor in 56 seconds using certain techniques. The techniques that you’re asking about are: Sit down, don’t multitask, and active listening. And we’re kind of getting into the article now, but being a genuine person. You know, share something personal about yourself. Use a little humor, of course not during breaking bad news, but during your everyday interactions as a family doctor or doing your hospital rounds, talking about yourself.

Once that patient views you as a person and not just a doctor or a nurse, the trust is built right there. So you might say, “Hey, I noticed you’re wearing a Yankees hat,” or, “I’m a Boston fan,” as you may be in New Hampshire, I’m not sure. But I’m a Red Sox fan. So just having that conversation, which takes just one or two sentences, will build that trusted relationship very, very quickly.

Kevin Pho: Now, of course, the elephant in the room is the electronic medical record. A lot of doctors have that computer in the room, and they’re often looking stuff up. They’re often typing their notes as they’re talking to patients. Now, what are some communication tips that you have for physicians, now that you have this third party in the room, which is the computer?

Anthony Orsini: Yeah. So we know, multiple books have been written, that multitasking is actually a myth. Your brain cannot do two things at one time unless one thing is done automatically. So you can walk and chew gum at the same time, of course, but when you’re listening to a patient and then going back to the electronic medical records, it’s been well documented that what your brain is actually doing is just multi-switching. You’re switching on and off.

But more importantly, the patient perceives that the doctor is not really paying attention and that act of listening. And so studies have shown they’re less likely to tell the doctor their concerns, and they’re less likely to ask questions. So I know it’s very tempting to type while the patient’s speaking, but it will send the wrong message. Your patient satisfaction and the patient experience really take a hit when you do that. So do the best you can, not trying to work and type on those electronic medical records.

Now, I said I work in one of the world’s busiest neonatal intensive care units. I hear a lot of physicians out there probably thinking right now, “I don’t have time for this. I don’t have time for this.” But studies have actually shown that if you multitask, you’re taking longer. So my advice would be, if you can afford them, there’s nothing like a good scribe. They can stand in the back of the room and take your notes for you. You’re saving time.

But if you can’t, give that patient your undivided attention first, and then go through your electronic medical records. And it’s extremely important: If you have to check a lab value, as you’re checking it, turn it around and say, “Let’s go over your labs together. Let’s look at them together.” Because now you’re saying to your patient, “We’re in this together.” But multitasking is always a bad message.

Kevin Pho: We’re talking to Anthony Orsini. He’s a neonatologist, and he’s the author of the book It’s All in the Delivery: Improving Health Care Starting with a Single Conversation. I think you’re a great person to ask this question, and I come across this: Can empathy really be taught?

Anthony Orsini: Empathy definitely can be taught, and it starts by understanding what it is. In fact, there are people who teach empathy. Dr. Helen Riess was recently on my podcast, and we had a conversation about it; she runs a program that helps train empathy. I take it the next step, and we talk about empathy and compassion. Empathy is understanding someone’s pain; compassion is wanting to do something about that. So if you ask me what I teach, I teach compassionate communication. I teach physicians and nurses how to bring that natural compassion that we all have and let the patient know, “I am feeling what you’re feeling, and I’m here to help.”

And you know, we hear a lot about physician burnout, by the way, and more and more studies are now showing that it’s the physicians and the nurses who block their emotions who are actually more likely to be burnt out than the ones who allow themselves to feel. So I would say that we’ll take this further, and yes, absolutely. When I teach physicians and nurses how to communicate compassionately, Kevin, I see their faces light up. It’s like I’ve unlocked the door. I told them it’s OK to feel. I hear from them years later saying that they feel so much better about their jobs and they’re connecting with their patients, and they’re still, by the way, going home at 5 o’clock. So it doesn’t take long to show that compassion inside you.

Kevin Pho: On this podcast, we have a lot of primary care clinicians, and you’ve given us so much great advice. Now, if you were to give us your highest-yield tip, or your top tip, what’s the number one thing that you would recommend for us to improve our communication skills?

Anthony Orsini: Number one would be: Sit down. And number two, a close two, would be: Be a genuine person. In the acronym that I discuss in my book, PROGRAM, the G is for genuine. Just take a few minutes at the beginning of that patient interaction. Be a real person. Talk about yourself, share something, find something in the room. I’m a firm believer, and I’ve been doing this for 25 years: No matter who the patient is, you can find something in common. Building rapport is about finding commonality. So once you build that rapport, the trusting relationship will follow.

So, my best advice: If you really look around the hospital and you look around at your colleagues, you will notice, Kevin, that the ones who seem to have the best practices, who seem to have the highest patient satisfaction scores, are genuine people. They have a big smile on their face. And I can teach you, by using communication techniques, tone, cadence, inflection of voice, and body language, how to show that and build that rapport. So the techniques, you can definitely learn how to do it. I hear a lot of people say, “Well, I’m kind of shy.” Believe it or not, I was shy when I was younger, but these are techniques that work. So my number one advice would be: Be genuine, sit down, and take your time.

Kevin Pho: And my final question: What is your take-home message that you want to leave with the KevinMD audience?

Anthony Orsini: My take-home message to all physicians out there, health care providers, and even business leaders, is pay attention to how you communicate. It is a skill that will get you extremely far in both your personal life and your private life, and most of us do not spend enough time learning, and it can be learned. If you’re a physician out there, the best thing that you can do to improve your clinical outcomes is to improve the patient experience by building rapport, being a genuine person, and communicating well. It will benefit you; you’ll feel less burnt out. It’ll benefit the patient, because there’ll be better outcomes. And if you’re in a hospital, the hospital administration will absolutely love you too. So it’s a win-win-win.

Kevin Pho: And how can people reach you?

Anthony Orsini: The best way to reach me is through my website, TheOrsiniWay.com, and I can also be reached at [email removed by the editor]. We do workshops, and we do improvisation role-playing, and now, because of COVID, we’re doing a lot of remote training. So feel free to reach out and ask me any questions.

Kevin Pho: Thank you so much for your time and insight, and thanks again for being on the show.

Anthony Orsini: Thank you, Kevin. It was an absolute pleasure. Have a great day.

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