In 2007, a physician solved a medical problem that had bothered medical communications consultant Edward Leigh for 15 years and taken him to a slew of health care professionals.
Leigh had severe sinus pain, which was usually mistaken for sinus headaches or allergies. Finally, an allergist did what none of the others had—she listened to him.
“She said to me, ‘Tell me, what brings you here?’ And I told her, ‘I have pain over here, pain here—it really is pretty bad,’ ” he recalled. “At this point, all the other physicians would say to me, ‘Is it worse on the right or on the left, worse when you stand or when you sit?’ …
“But she did something very different. She said to me, ‘Go on.’ “
After some gentle prodding from this physician, Leigh said the pain sometimes made him vomit, and she told him he had migraine headaches.
“How do you take 15 years to be diagnosed with migraine headaches?” he asked the audience. “Because no one gave me a chance to tell my story. They immediately started cutting me off.”
Leigh, who directs the Center for Healthcare Communication in Cleveland and coaches physicians on bedside manner, told this story in an OMED session on Monday to remind physicians of the importance of listening to patients. Listening and other aspects of bedside manner are critical to patient satisfaction and can improve compliance, Leigh said.
To bolster listening skills specifically, Leigh recommended physicians start visits by calling patients by their name, greeting any caregivers or family members in the room, and asking an open-ended question such as “What brings you here?” Then, physicians should resolve to let the patient talk for at least one minute before weighing in or asking any questions.
Empathy and patient visits
Beyond listening, physicians can strengthen their relationships with patients by empathizing with them, Leigh said. Many physicians think being empathetic takes too much time, or they miss emotional cues because they focus on the clinical aspect of the visit. But it can take as little as 60 seconds to respond to a patient’s emotional statement—and doing so often pays dividends in the form of a better patient-physician bond.
To start, physicians can listen for clues about a patient’s life and comment on them, Leigh said. For instance, during one clinical encounter Leigh witnessed, the patient told the physician about her daughter’s wedding invitations.
“And I said to the physician, ‘At that point, what you do is say, ‘Tell me about the wedding, that must be so exciting,’ ” Leigh said, noting that just a moment of small talk can show genuine interest and establish rapport.
Then, to respond appropriately to patients’ concerns, physicians must hear them out and listen for statements expressing fear, sadness or distress, Leigh said.
If a patient talks about being worried that a test result will reveal he has cancer, Leigh suggested statements such as “I understand this must be frightening for you. I understand this must be scary for you.” When a patient mentions that work is difficult because she is running to the bathroom all day, a physician can respond, “I understand this must be frustrating for you.”
Patients are more likely to trust and follow directions from a physician with whom they feel a connection, and empathy is often necessary to form that bond, Leigh said.
Physicians can also improve compliance by approaching treatment as a team project rather than a one-sided venture, Leigh said. He advised putting patients at ease with a partnership statement such as “I understand this is happening to you, but we will face it together.”
“I interviewed one patient who had a colonoscopy that revealed she had a tumor,” Leigh said. “She told me what the doctor said to her [after sharing the results]: ‘I will be with you every step of the way.’ “
Enhancing patient comprehension is another way to work on compliance. Leigh suggested avoiding medical jargon in conversation and giving the patient additional resources to review, such as brochures, readings and websites. Physicians should familiarize themselves with any brochures they plan to give patients and go over the literature with the patient in the office, Leigh said. He cited an example from his own life—the day a health care professional recommended Fitday.com, a free online food diary, after Leigh told her how tedious it was to count calories every day.
“When I got the survey in the mail, I just gave a glowing review, saying that Fitday made such a difference for me,” he said.
Audience member Martin G. McElya, DO, said he was pleased the presentation emphasized practical examples, and he said Leigh shared a few ideas he plans to use himself.
“I liked the fact that he talked about trying to establish a rapport with the patient in such a way that you recognize the patient’s feelings first and the facts of the disorder second,” said Dr. McElya, a family physician from Dallas. “I liked his suggestion to say something like, ‘I bet you’re really upset by this finding. Let’s talk about how we can work on it together.’ “