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Feature: Louder than words 

01-17-2017 13:09

Communication skills that lead with empathy can improve patient–doctor relationshipsnRSQvaUhRsidBzdkyI3v_Twitter_Bird2.png


nVNiFpioQLeXF4XFkqeu_winter2017_f3_lrg.pngAs interventional radiology has morphed from a procedure-based subspecialty to one recognized for its focus on patients, the style of communication with those patients has needed to change as well.

Developing quality relationships with patients in a clinical practice model can improve patient understanding and compliance and lead to overall patient satisfaction—plus lead to patients praising and promoting your practice to friends and family. However, it all hinges on effective communication.

“Today’s IRs have to learn how to communicate not only to the other doctors who are involved in the patient’s care but also the patients themselves,” says Gary P. Siskin, MD, FSIR, professor and chair of the department of radiology at Albany Medical Center in Albany, N.Y. Dr. Siskin was a coordinator of an M&M symposium held at SIR 2015. “An IR who is successful in a clinical practice model must be able to have intelligent and appropriate conversations with patients coming into their appointments with different levels of knowledge about their illness. The language that you use may be completely different for different patients,” Dr. Siskin continues, “but the common thread for every encounter is that you can’t let the patient go until you know that they understand what they’re going to have done.”

Studies that compare physician self-surveys to patient satisfaction surveys show that doctors tend to overestimate their communication skills, says Wendy Leebov, EdD, partner and founder of the Language of Caring ( Dr. Leebov has spent 35 years training physicians and staff at practices and hospitals on how to communicate with empathy, which builds relationships and earns trust.

Effective communication does not simply come down to an individual’s personality and soft skills, says Dr. Leebov, who teaches physicians identifiable skills in areas such as mindfulness, effective openings and closings, difficult conversations, effective explanations, communicating with empathy, and engaging patients and families as partners.

Many physicians communicate by focusing on the problem, diagnosis, plan of action and explanation of the procedure, what Dr. Leebov calls “communication from the head.”

“Meanwhile, patients are anxious, and they’re looking for communication from the heart,” she says. “So, frequently there is a gap. [The doctor’s] caring isn’t felt if they’re focused on the information, the alternatives, the choices, the plans. There needs to be explicit communication of caring in the relationship.”

Nowadays, an added challenge is the use of electronic medical records. Patients often feel doctors aren’t paying attention or aren’t interested when they are inputting information into a medical record on a computer in front of them.

“Navigating that tightrope so you can do so in a patient-centered way and maintain your connection with the patient throughout those communications is a big challenge,” Dr. Leebov says.

Dr. Leebov offers several ways physicians can improve their patient interactions:

  1. Embrace mindfulness. Physicians can learn how to discipline their minds to be in the moment, calmly listening and acknowledging a patient’s feelings. “Giving people full attention is the No. 1 way to make people feel a connection with a physician,” Dr. Leebov says.
  2. Communicate with empathy. Research shows that empathic communication can not only improve a patient’s perceived experience but reduce readmission rates and improve clinical outcomes, according to Dr. Leebov. One small step is for physicians to pay attention to a patient’s verbal and nonverbal behavior, then take a guess at what the patient might be feeling and acknowledge it. You could say things such as “I realize this might be uncomfortable for you” or “I can imagine waiting for the results might be anxiety-producing” or “You look frustrated.”

Even though you are guessing at the feelings, it leaves room for the patient to confirm or correct you. “Even if you’re wrong, when you try to acknowledge people’s feelings, they feel your empathy,” Dr. Leebov says.

  1. Explain positive intent. Point out what you are doing in a way that highlights the benefit to the patient. Instead of simply placing a cover over a patient before a procedure, say, “I want you to be comfortable.” Or before talking about results, say, “I want you to know what you can expect.” These types of explanations show patients that you realize what they’re going through.
  2. Offer a blameless apology. Physicians are often wary of apologizing in any way, but research shows that apologizing can be one of the best ways to prevent a lawsuit. The blameless apology is an empathic way to say “I’m sorry” without taking blame or responsibility, Dr. Leebov explains.

“What you express is your sincere regret that the person is having an uncomfortable or unwanted experience,” she says.

You can use phrases such as “I’m so sorry this has been uncomfortable for you” or “I’m sorry the procedure has been so hard for you” or “I’m sorry this happened to you.” “I’m sorry” is a powerful phrase that many frustrated or angry patients wait to hear from their physicians and, when they don’t, the anger and frustration can mount, Dr. Leebov says.

“Being honest and open with the patient is the right thing to do,” Dr. Siskin says. “Obviously, if there was an adverse outcome, it’s always best if you discussed that possibility before the procedure.

“Make sure they understand why this happened,” Dr. Siskin continues, “and make sure they understand what you are going to do to try and help them through the situation and then act as their advocate. The other thing is, of course, to document all of that in the medical record.”

Having serious conversations about potential negative outcomes or delivering any type of bad news can be difficult for physicians, says Constantinos T. Sofocleous, MD, PhD, an interventional radiologist at Memorial Sloan Kettering Cancer Center in New York City and another coordinator of the SIR 2015 M&M symposium. “Very often, I have patients in clinic that come with very high expectations that I’m going to cure their cancer forever,” he says.

He faces tough questions: Will I die? Will my cancer come back? Even though these patients have usually seen several other physicians related to their case, Dr. Sofocleous sometimes finds that their questions have not yet been addressed or answered in a way they embraced. He says physicians must be sensitive and understand each patient’s expectation and concerns.

“You will address very differently a very young patient who is extremely anxious than an 85-year-old grandpa who doesn’t even want the procedure but the family is pushing him to have it,” Dr. Sofocleous says.

Committing to a clinical practice model

As more IRs recognize the value of a clinical practice model, it is critical for them to become experts in the disease they are treating, Dr. Sofocleous says.

“Interventional radiologists are great at doing procedures that treat many diseases and conditions, but they may not know the disease the same way that a medical oncologist or a vascular surgeon or an endocrinologist would know the disease,” he says. “[We tend to] focus on the procedure, rather than on the disease. That needs to shift. We need to be specialists in the disease also.”

“I think the most important thing is to make the commitment to a clinical practice model,” Dr. Siskin says. “It’s not something you can do part-time. You really have to make it the focal point of your practice. For every patient you see, you have to think about the interaction you’re going to have, not just during the procedure, but before and after the procedure as well.


5 social media communication strategies

Communication skills that physicians develop to build relationships with patients can be effective on social media also—although they should be used more to educate and build a practice, not to offer medical advice, says Richard Duszak, MD, professor and vice chair for health policy and practice in the department of radiology and imaging sciences at Emory University School of Medicine in Atlanta. Dr. Duszak, who has published and lectured on physician use of social media, offers these five social media tips: 

  1. Determine your goals and target audience. Are you aiming to build your practice? Bolster your reputation as an expert among other physicians in your area of interest? Expand awareness of your institution’s excellence in a particular area? Educate your local community on specific health issues?
  2. Keep your target audience in mind when developing and sharing content. Your content should be aligned with your goals. What message are you trying to get across to your target audience? For example, if your message is that patients should choose you first when they need a uterine fibroid embolization, your practice or physician Twitter feed might share articles about uterine fibroids, tweet about the latest research with your opinion, and promote any awards or recognition you’ve received in your field. You don’t want to come off as a salesman though, Dr. Duszak says. Don’t directly market by saying, for example, “Come to our office for the best uterine fibroids treatment around!”
  3. Don’t go off topic or discuss unrelated controversial issues. Dr. Duszak established a few rules for himself, including focusing primarily on discussions related to health care policy, health economics and patient experience. “I have steered as clear as possible of any political issues and focused on what’s good for the system and the community. I think that’s led to a lot more engagement.”
  4. Don’t spread yourself too thin. If you try to be on too many social media platforms, it’s as if you don’t have any social media brand, Dr. Duszak says. Some physicians might find Twitter most effective, while others prefer Facebook or another platform. Pick a few you are good at and stick to those.
  5. Find the right voice. Don’t be so rigid that you’re boring, he says. Show you’re human: “If you want this to be your professional clinical face, social media is what you’d talk about with patients in the exam room. If you want this to be your academic face, it’s what you would talk about with colleagues.”

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