Ever get the feeling that your patient is holding back from asking questions related to their condition? This might be occurring because you appear burned out and the patient is avoiding asking questions for fear of adding to your stress.
Studies by The Doctors Company of over 25,000 malpractice claims show that poor communication between patients and providers leads to patient harm and malpractice claims. And a recent survey of more than 2,000 U.S. adults, sponsored by the American Society of Health-System Pharmacists, shows1:
- 47 percent avoid asking questions if they think their provider is burned out to avoid overstressing them.
- 74 percent say provider burnout is a major concern.
- 91 percent feel it is important for their provider to do whatever is necessary to avoid burnout.
- 77 percent are concerned about their own care and safety when they notice their provider feeling burned out.
Patient safety is at risk when patients avoid asking questions they feel may add to an already difficult job. Something of clinical importance could be omitted from the patient encounter, potentially leading to an undiagnosed condition or other adverse outcome.
This avoidance of questions in the presence of an apparently burned-out provider aligns with findings from a 2018 Canadian qualitative study of patient perceptions of physician wellness. Although this study involved a small sample size of 20 patients, it offers some additional insights. The study found that patients notice cues (demeanor, physical appearance, organizational skills, work pace, general impression, and others), which they link to physician wellness.2 From these cues they make judgments that affect their views about their care, levels of trust, and adherence with care plans.2 Patients’ perceptions of doctor unwellness impacts how they feel about their care, what they do and don’t do, and what they say and don’t say. Some feel compassion and concern, some worry about the effectiveness of the encounters, and others limit the number of problems they discussed or minimized symptoms to avoid overwhelming the physician.2
Another key conclusion from the study: “Patients perceive a bi-directional link between physician wellness and patient care. Physician wellness impacts patient care, but physician wellness is also impacted by the care they provide to patients.”2 This is exacerbated by an increasingly complex system that demands too much of healthcare professionals. The authors suggest patients could be advocates for changes that support provider well-being and effectively address the flaws in our healthcare system that lead to burnout.2
The Doctors Company’s analysis of closed malpractice claims found that poor communication is the third most common factor that contributed to patient injury, identified in 34 percent of claims. Communication between patient/family and providers is the most common category, identified in 62 percent of cases with a communication issue and 21 percent of all claims and suits.
Some of the contributing factors that lead to a breakdown in communication between patients/family and providers are:
- Poor rapport, including unsympathetic responses to patients.
- Incomplete explanations regarding risks of medications.
- Unclear instructions for discharge and follow up.
- Inadequate informed consent for other treatment options.
- Poor communication about expectations.
We encourage all providers to raise awareness in their medical practices and develop strategies to address this issue. To prevent patient reluctance to communicate with healthcare providers, strategies may include:
- Self-awareness and recognition of the moment. Take a few seconds to check yourself and find your own center of equanimity.
- Taking a moment to make a personal connection with patients. Look them in the eye long enough to know their eye color and say their name.
- Making a statement to encourage your patient to ask their questions despite any reluctance. Also, asking the patient, “What is it about this that worries you the most?”
- Asking, “What questions do you have?” instead of, “Do you have any questions?”
But most importantly, if you feel you are suffering from burnout, get help. You are not alone. A growing number of medical societies have implemented physician wellness programs that provide a variety of resources and confidential support for those in need. If a program is not available through your regional society chapter, you can contact the chapter about building a program. A free toolkit for building such a program is available at http://www.physicianwellnessprogram.org/.
- American Society of Health-System Pharmacists. Three Quarters of Americans Concerned about Burnout Among Healthcare Professionals. Press Release June 17, 2019. https://www.ashp.org/news/2019/06/17/clinician-wellbeing-survey. Accessed September 14, 2019.
- Lemaire JB, Ewashina D, Polachek AJ, Dixit J, Yiu V Understanding how patients perceive physician wellness and its links to patient care: A qualitative study. PLoS ONE (2018) 13(5): e0196888. https://doi.org/10.1371/journal.pone.0196888.
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.