BECAUSE PATIENTS JUDGE YOUR SKILLS BY YOUR BEDSIDE MANNER
A terribly overweight woman goes to the doctor to find the perfect diet. “I want you to eat regularly for two days then skip a day. Do that for two weeks and when you come back you will have lost five pounds.” When she returned, she shocked the doctor by losing twenty pounds. “Why, that’s amazing. Did you follow my instructions?” The woman nodded. “I did, but I thought I would drop dead by the third day.” “From hunger?” asked the doctor. “No, from the skipping.”
As one of the pillars of bedside manner, the benefit of communication cannot be overemphasized. Not only will your patients benefit by being more compliant when they understand instructions, but you will prevent many costly, stressful, time-consuming lawsuits.
Two areas of professional practice require strong communications skills: treatment plans (including description of treatment, other options, expected outcome, and postoperative sequelae), and financial considerations.
COMMUNICATING THE TREATMENT PLAN
When a patient understands their treatment plan, they have more realistic expectations of outcome, are better able to respond to adverse consequences, and they will trust and respect you even if things go wrong.
There is no better way to communicate a procedure than by employing a visual aid. You don’t have to take courses in art unless your sketching skills are as bad as your handwriting. Assuming you can draw a reasonable diagram of the planned procedure, you’ll be fine. Always sit next to the patient so they can see your illustration as it comes to life. Be sure to make notes alongside the drawing regarding your discussion. Your notes should cover options for other forms of treatment (including the choice to ignore treatment), the prognosis, postoperative considerations, and cost. Once you complete your presentation, you can give the patient a copy of the diagram.
Patients often find they can’t remember or explain anything you told them when they get home. With a drawing, they have half a chance. More importantly, they appreciate your personal interest in explaining the problem and procedure in a clear and understandable manner. To provide a formal consent form based on legal advice with all sorts of disclaimers and highly complex descriptions is all right for your records, but it can’t compare to an uncomplicated picture that is made personally for each patient.
Drawings are of great benefit when a patient claims they didn’t understand something. In crucial instances, you will be able to calm the most aggressive of patients by producing your diagram and pointing out how you discussed the fact that the procedure may not be successful, or the fee, or the consequences of treatment. By the time they get home, many patients forget much of what you said during the consultation. And what they remember may be selective, such that they forget the risks you explained. With a drawing, you have physical evidence outlining the major points of the consultation. This provides you with a reasonable informed consent that can protect you if the patient decides to take legal action.
When beginning your explanation of a treatment plan, or when discussing problems arising from treatment, always tell the patient you will take time at the end of the presentation for questions. This will prevent constant interruptions. Although, you shouldn’t hesitate to answer questions as you proceed if you are interrupted.
Never rush patients when they ask questions, especially if they need to see you after you’ve performed a treatment and they have adverse consequences. No matter how far behind schedule you’re running, rushing patients experiencing complications leads to bad will and potential lawsuits.
At various intervals during lengthy explanations, you should ask the patient if they understand. Waiting until you are finished to answer their questions may be confusing, especially for the elderly.
A Dental Specialist Says
You present differently to a CPA versus a nurse versus an engineer versus a hotel worker. What the patient wants to know is: Do you understand the problem? Are you qualified to fix it? Can you fix it? Have you done this before? Do other people have this type of problem and will you fix it with the least amount of pain and minimal complications? It’s my job to communicate the answers to these questions. Communication and trust require eye contact. I look directly into my patient’s eyes when I speak with them.
A major flaw in communication is to assume every patient is as knowledgeable as you are. Something as simple as a technical word you take for granted can destroy an entire explanation: “The tissue is inflamed, resulting in a productive cough.”
‘Tissue’ is Kleenex to many, and ‘productive’ means getting the job done. While you may be smiling at the absurdity of this example, it is not at all absurd, and you will understand this when you are a good communicator. By watching for body language you may pick up on moments when patients don’t understand and you can slow down or explain over again when necessary.
There was this couple whose husband experienced the loss of libido. Upon returning from the doctor he entered the house wearing a tuxedo. His wife asked anxiously if he had seen the doctor about his problem. “Of course!” he replied.
“Well, why are you all dressed up in a tuxedo?” she queried.
“The doctor said I’m impotent, so if I’m impotent, I figured I should look impotent.”
There are many words that should be stricken from your vocabulary when speaking with patients. Here are some examples and proper ways to say the same thing.
Avoid using the term "incision." Instead tell your patients "I will make a small opening"
I&D means nothing to most patients, however, they understand, "We are going to release the pressure."
Going under the knife? Can you sound any more barbaric? Try, "You need a minor surgical procedure."
Purulent drainage is pus to the layman. Use their language.
Who knows what a patient might think when you tell them you are laying a flap? It is much more comprehensible to tell them you are going to “pull back” the gum, skin or whatever you are operating upon.
Curetting is clean out, enucleating is removing, and an exploratory operation sounds much better if it is described simply as you "are going to look around."
The term “prognosis” is used all the time. Stop using it with your patients. "The chance of this working out" is much easier to understand. Yes, there are patients who have no idea what prognosis means and they are too embarrassed to ask.
Sure, you didn’t go to medical school to speak like an idiot, but you have to communicate to your patients in a clear, non-threatening manner if you want to have the best bedside manner.
It is a great idea to get a small digital recorder and listen to at least a dozen of your presentations of treatment plans or explaining procedures. You may be surprised at how you sound to your patients.
Despite your best efforts, there are some patients who will never fully understand your explanation of a complex procedure. To offer the best possible service and chance of success, you should always have written instructions for each procedure you perform.
Written instructions are a wonderful way to enhance the way you communicate with your patients. While some patients don’t understand anything you tell them, never read your instructions, and are not very compliant because of their lack of understanding and lack of interest, there are those who appreciate the written word.
A PICTURE IS WORTH A THOUSAND WORDS
With procedures that may be more involved, it is best to make a drawing for the patient that explains everything deemed important. You make this drawing as you sit next to the patient and allow them to ask questions as the need arises. You jot down your discussion using key words and include other options of treatment (including doing nothing), chances for success and failure i.e. prognosis, and a general explanation of the treatment procedure. Make sure your explanation is understandable.
Your diagram becomes proof that you provided a verbal informed consent. Your patient will appreciate your personal interest in their case, and the clear manner in which you explained everything to them. The diagram is there to show the patient when controversy arises, such as complications, flare up or failure to achieve the expected outcome. This picture makes a great exhibit in court. While some patients don’t understand no matter how hard you try, the picture shows you tried.
You should be explaining things to the patient anyway, and the time it takes to make a drawing that is included in your records is well worth the effort. Remember, if the jury can understand your explanation and they like your picture, they will be sympathetic to your cause.