Time constraints, technology and administrative demands often impede on the human connection that is central to clinical care. This can contribute to physician burnout and patient dissatisfaction. To provide quality care and reduce burnout, it is important to address patient-physician communication. A JAMA study offers five ways to enhance physician presence and create a meaningful connection with patients.
Published in JAMA prior to the COVID-19 pandemic’s onset, the study, “Practices to Foster Physician Presence and Connection With Patients in the Clinical Encounter,” looks at the most promising practices to foster physician presence and connection with patients.
Researchers conducted a literature review of effective interpersonal interventions, and observations of primary care encounters in three diverse clinics. The team of researchers also conducted qualitative interviews with physicians, patients and nonmedical professionals whose occupations involve intense interpersonal interactions.
Mismatch of time and expectations is associated with physician frustration, emotional exhaustion and burnout, says the study. Improving patient-physician communication and relationships can help reduce physician burnout. Here is how to facilitate meaningful interactions with patients.
Prepare with intention
Prepare with intention
The physician needs to become familiar with each individual patient. In settings that distribute pre-visit questionnaires, review the patient’s responses before an appointment to increase patients reporting that they received information about their health and medications.
If a physician does not have time to pre-chart, ask a nurse or medical assistant to report any important patient-reported information obtained while rooming. The AMA STEPS Forward™ module “Pre-Visit Planning” offers steps to save time and improve patient care.
Physicians should also take a moment before or at the beginning of the visit to clear their mind of distractions while setting the intention for the upcoming encounter. For example, while handwashing, focusing one’s attention might remind physicians that they are “entering a hallowed space,” says the study. Another option is to take three deep breaths before walking into the exam room.
Learn more from the AMA about how burnout can hinder patient-physician communication.
Listen intently and completely
Listen intently and completely
It is important to “listen with one’s whole body using open and receptive body language.” This involves nonverbal behaviors that convey openness and facilitate listening. For example, sit down, lean in, maintain an open body position and orient your body toward the patient. Thoughtful physician body language and positioning has been shown to support relationship building, trust and patient satisfaction.
Physicians should avoid interrupting patients, especially during their initial description of active health issues. When doctors actively listen, patients communicate more, provide more medical information and report higher satisfaction.
The AMA STEPS Forward module “Empathetic Listening” offers insight and steps to improve the patient experience by understanding patient needs and values.
Agree on what matters most
Agree on what matters most
“Understanding what matters to a patient is at the core of patient-centered, humanistic care, and when achieved early in the visit, helps set the stage for meaningful encounters,” says the study.
A collaborative agenda can help reduce last-minute new concerns, improve patient satisfaction ratings and positively influence symptoms, including pain and anxiety. One way to do this is through open-ended questions that ask a patient to describe in their own words what brings them into the clinic.
At the end of the visit, ask, “Is there something else you want to address in the visit today?” to reduce the number of unmet concerns and improve the patient’s perceptions.
Connect with the patient’s story
Connect with the patient’s story
Consider the personal circumstances that influence a patient’s health. This can include being curious and creating a connection by asking the patient about their sociocultural background and life circumstances. When physicians show active consideration of a patient’s perspective, it creates an atmosphere of shared presence, which can directly influence the quality of care.
Physicians should also focus on the positive by acknowledging specific patient efforts in a genuine and positive way. It is also important to offer genuine praise for what the patient has accomplished.
Explore emotional cues
Explore emotional cues
Read the patient’s verbal and nonverbal emotional cues and try to elicit patient feelings through questions like “How are you feeling about this?” Interpersonal sensitivity from a physician is associated with positive patient outcomes, including patient satisfaction, appointment adherence and learning of conveyed information.
Individuals’ emotional sensitivity may vary, but patients do appreciate physician attempts to elicit and identify their emotional cues, even if mistaken.
The AMA offers resources to help physicians manage their own mental health and well-being during the COVID-19 pandemic and provides practical strategies for health system leadership to consider in support of their physicians and care teams during COVID-19.
