Strong Working Relationships
With Patients Protect
Healthcare Practitioners

Summary

It’s a mistake to value technical expertise at the expense of rapport with the patient. Patient-centered communication weaves a safety net under clinicians if events take an unexpected turn.

Recently, a new patient arrived expressing dissatisfaction with a cardiologist who had told them that there are only two causes of atrial fibrillation. This other cardiologist reportedly said: “You either have sleep apnea, or you drink too much.”

I acknowledged those two causes but also listed others, such as valvular disease, thyroid issues, and electrolyte abnormalities. My patient said the other cardiologist had been adamant—and had told the patient that if they didn’t like hearing an unpleasant truth, then they could leave.

Good Communication Can Save Lives, Sanity, and Resources

New research published in the Annals of Internal Medicine has shown that poor communication contributes to 24 percent of patient safety incidents, and it is the sole identified cause in 13 percent of incidents. Similar findings permeate The Doctors Company’s closed claims studies (and the bulk of risk management literature). For example, in The Doctors Company’s study of closed claims against cardiologist members, one-third of allegations were related to diagnosis, and contributing factors related to communication featured prominently.

Fortunately, effective physician-patient communication has the power to improve patient adherence and patient outcomes. It reduces both the odds that something will go badly for a patient and the odds that the patient will allege malpractice if it does.

Patient-Centered Terminology Builds Rapport

In the U.S. overall, just 12 percent of our patients are highly health literate. Many people nod along to be polite or may be afraid to ask for clarification, so let’s remember that cultivating a strong working relationship with a patient begins with simply establishing a sense of give and take.

For a model, we might look to our personal relationships. I have friends who can change a timing belt on an engine or chainsaw a tree, and I don’t always speak their lingo—every activity has its specialized knowledge. To a patient, I might explain atrial fibrillation in terms of the more familiar “atrium.” I’ll note that an atrium is where you receive things. Your heart has two atria, which are the receiving chambers. And so on.

Hopefully, in each clinical encounter, we’re trying to understand the patient’s level of health literacy to meet them where they are with patient-centered terminology. It’s easy for me as a cardiologist, or for you in your specialty, to wow the patient with brilliant “medspeak,” which is what the American Medical Association (AMA) calls those long Latinate phrases from the patient’s perspective. But medspeak isn’t very helpful, even if I’ve said something brilliant, when the patient doesn’t understand it.

We know that poor patient satisfaction connects to a lower rate of adherence and a higher likelihood of alleging malpractice. On the other hand, research confirms that a strong interpersonal relationship between physician and patient can exert powerful protective effects.

The High Wire and the Safety Net

Rapport is a safety net. It is woven from threads of both interpersonal connection and patient understanding, so that in case of a known complication, the patient can say to themselves, “Well, he did explain it to me. I did understand there were risks.” But without understanding, there's no rapport—and no safety net.

Communication With Structured Tools

In our daily practice, structured communication tools can help us, like the balancing poles that tightrope walkers hold to keep their bearings. They can remind us of our commitment to patient safety and our imperative to protect ourselves and our practices from preventable liability exposure. I found the AMA article on RESPECT: Rapport, Explain, Show, Practice, Empathy, Collaboration, and Technology very helpful.

R—Rapport: Nonverbal cues like eye contact and overall demeanor can demonstrate present-minded attention.

E—Explain: Give patients opportunities to fully explain their symptoms in the context of their life outside of healthcare. This can aid accurate diagnosis.

S—Show: Consider providing access to educational materials, trustworthy websites, or support groups.

P—Practice: Anyone can choose one aspect of communication to practice improving.

E—Empathy: Some patients are embarrassed to disclose symptoms; others don’t want to admit that they haven’t adhered to their treatment plan. Empathy invites more accurate information from the patient.

C—Collaboration: Patients are more likely to follow your recommendations in a collaborative atmosphere.

T—Technology: Be selective with communication channels, and stick with patient-centered terminology in written communication.

What Gets in the Way?

If a clinician’s working relationship with a patient can help shield the patient from poor outcomes and the practitioner from liability, why aren’t all of us getting to know our patients better? What is getting in our way?

Answers include staffing shortages, production pressure, time pressure, lack of education in bedside manner—and lack of willingness to ask for help.

It Takes a Team to Promote One-on-One Focus

One morning, I was in the cardiac catheterization lab for a case that should have taken three minutes. However, the patient’s unusual anatomy had us trying one catheter after another, then changing sites from the wrist to the groin, and then calling in a colleague. To make a long story short, a three-minute procedure took an hour and a half.

Meanwhile, my office staff members were relaying requests for a call back from the ER, a patient’s primary care physician wanted to talk to me, and so on. I gave a status update: “Please ask my partner to pick these up. I will get back to you as soon as I’m done.” My partner could handle those communications, no problem, but my front office was unaware I needed assistance.

Now we’ve come full circle: In order to maintain my personal focus on the patient in front of me, I need excellent collegial collaboration.

Sit Down, Connect, Focus

When residents rotate with us and they have questions about rapport with patients, I tell them to sit down, connect, and make the patient the most important thing at the moment—because they are. If things go badly, I tell them, you're going to want to say, “I gave it my all here, even though it didn’t go well.”

We can’t control all outcomes, but we can know that we showed up and were mentally present to help the patient. We can know that we engaged in a true conversation.

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The Doctor’s Advocate is published by The Doctors Company to advise and inform its members about loss prevention and insurance issues.

The guidelines suggested in this newsletter are not rules, do not constitute legal advice, and do not ensure a successful outcome. They attempt to define principles of practice for providing appropriate care. The principles are not inclusive of all proper methods of care nor exclusive of other methods reasonably directed at obtaining the same results.

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.

The Doctor’s Advocate is published quarterly by Corporate Communications, The Doctors Company. Letters and articles, to be edited and published at the editor’s discretion, are welcome. The views expressed are those of the letter writer and do not necessarily reflect the opinion or official policy of The Doctors Company. Please sign your letters, and address them to the editor.