The Case for Doctor-Patient Communication to Improve Healthcare Quality
Conversations in healthcare settings are a cornerstone of healthcare delivery – the foundation of doctor-patient communication. Patients expect that their healthcare providers have undergone rigorous medical training in order to be able to diagnose and treat patients. However, diagnosis and treatment are really a small piece of their role in practicing medicine.
All providers must communicate with patients to provide safe and high-quality care. But this communication is not one-sided; rather it involves mutual participation. What is involved in that exchange, and what are techniques to ensure that it’s effective?
What is doctor-patient communication?
Patients and providers know that accurate information is important. But how this information is conveyed is just as important. For example, medical information should be easy to understand and conveyed in a way that encourages dialogue between patient and provider.
The Joint Commission defines effective communication as:
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The successful joint establishment of meaning wherein patients and health care providers exchange information, enabling patients to participate actively in their care from admission through discharge, and ensuring that the responsibilities of both patients and providers are understood.
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To be truly effective, communication requires a two-way process (expressive and receptive) in which messages are negotiated until the information is correctly understood by both parties.
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Successful communication takes place only when providers understand and integrate the information gleaned from patients, and when patients comprehend accurate, timely, complete, and unambiguous messages from providers in a way that enables them to participate responsibly in their care.
This definition encompasses not just exchange of information, but also the manner in which that information is communicated: in a way that both parties understand and feel ready to act upon.
Why is communication in healthcare important?
Research on doctor-patient communication shows both the impact of poor communication on negative outcomes and effective communication contributing to positive outcomes. Further, evidence supports that communication skills are an essential competency to deliver value-based, patient-centered care.
- It can improve patient safety: ensuring that patients are informed and involved helps reduce medical errors. A study found that 32% of nursing malpractice claims were caused by at least one breakdown in communication. Another study found that more than 70% of adverse events were caused by breakdowns in communication
- It can improve patient outcomes: for example, patients who feel motivated are more likely to adhere to a prescribed regimen correctly. A literature review on patient-centered communication demonstrated a positive association between physician communication and patient outcomes. This included patient recall, patient understanding, and patient adherence to therapy. Better communication also contributes to improvements in emotional health, functioning, and pain control.
- It can improve patient experience: how patients perceive their care experience is linked strongly to communication. For example, effective communication among care team members and with patients has been linked to an increased likelihood for patients to recommend the organization and to rate their overall care more highly. When hospitals improve nurse communications with patients, they see associated gains in patient experience measures.
What does good communication in healthcare settings look like?
Professional and academic organizations are beginning to define elements of communication skills for healthcare professionals.
The Accreditation Council for Graduate Medical Education recommends that physicians become competent in interpersonal and communication skills, including:
- Listening effectively
- Eliciting information using effective questioning skills
- Providing information using effective explanatory skills
- Counseling and educating patients; and
- Making informed decisions based on patient information and preference
According to The Joint Commission, elements of strong doctor-patient communication are:
- Clear expectation setting
- A patient-centered approach to communication that ensures patients play an active role in the dialogue
- Expression of empathy
- A focus on clear information exchange and patient education that promotes the understanding and retention of key information
Why isn’t doctor-patient communication training standardized?
Dr. Calvin Chou writes in the New England Journal of Medicine:
Would you trust a surgeon who told you, “I haven’t had any formal training for this procedure, observed any experts, nor received feedback on my skills, BUT over the course of time, through trial and error, I think I’ve found what works for me”? That is essentially how physicians were “trained” in communication skills for decades.
The reality is that a focus on doctor-patient communication is relatively nascent. Education and training for healthcare professionals vary and result in different methods and communication styles. Further, patients are incredibly diverse when it comes to knowledge level, health literacy, social determinants of health, beliefs, and other factors. There is no one-size-fits-all conversation that will apply to all patients; quality care depends on meeting the unique needs of patients, one at a time.
With research indicating that effective doctor-patient communication delivers safer care, high-quality care, and more cost-effective care – all of which drive value in healthcare – it makes sense to invest in these skills for health professionals.
How should healthcare organizations focus on doctor-patient communication?
To enhance patient safety and quality, there are a variety of evidence-based best practices that help healthcare organizations enhance communication skills.
One solution is investing in communication skills training for all staff. This could include techniques such as the use of open-ended questions, motivational interviewing, and more. Schools of health professions can also focus on incorporating doctor-patient communication early into curricula.
Being ready to sit down with a patient equipped with effective communication skills probably won’t happen overnight or come naturally. Rather, it requires training and ongoing practice. Luckily, there are many advantages to building these skills for physicians, nurses, social workers, and future healthcare professionals to deliver high-quality care.
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