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On Being a Doctor

Improving Communication

Other Tips to Enhance Communication with Your Patient

    • Do not expect the same level of stoicism from patients that you expect from yourself. Learn to recognize cultural and personality- and more traditional sex-related differences in the expression of pain, anger, and grief.
    • Make a point of chatting with your patients and try to learn at least one fact about their lives that will make them more human to you (e.g., the man with dementia on 8D used to be a composer).
    • Let positive counter-transference happen consciously and selectively (e.g., 'that old lady in the emergency department hallway could be my grandmother').
    • Remember your own experiences of illness, loss, discomfort, and vulnerability. These may differ from those of your patients, but the memory will help to link you in understanding.
    • Do not be afraid to let your patients express their emotions. If you are afraid, find out why in therapy, in supervision, or in a resident support or Balint-style group rather than refer the patients for psychiatric treatment. When appropriate, consider acknowledging your feelings to your patient (e.g.,'I am tired today because I was on duty all night').
    • Get to know your patient's family when possible, and try to be available for brief education sessions. This may help your patient cooperate with your treatment, which will diminish your workload.
    • Identify your patients' psychosocial needs. After you have done the groundwork, you may want to recruit help from the departments of psychology or psychiatry, social work, and chaplaincy. But do not call them in simply because you do not want to deal with these needs. You must not dilute your responsibility to your patients.
    • Study your referral patterns to see whether you avoid certain problems with patients.
    • Keep informed about key psychosocial issues, which often manifest themselves in patients if you take the trouble to ask.
    • Be sensitive to the patient's feelings of being undressed or exposed. Knock before entering a room.
    • Maintain good eye contact with the patient; avoid taking excessive notes.
    • Ask how the patient would like to be addressed (first name/title) and make sure he or she knows your name.
    • Try to sit or stand at the same level as the patient so as not to be intimidating.
    • Increase cross-cultural awareness by asking about your patient's background, learning of new language skills, and reading. Where appropriate, use a professional translator, or if necessary, a family member.
    • Don't get angry about non-compliance with medication or treatment. Explore the patient's fears, misconceptions, side-effects, and financial worries (re: drug cost) instead.
    • Use open-ended questions and don't interrupt.
    • Ask the patient about fantasies ('What do you think it is?'), feelings, fears, and expectations about the illness. Find out what has changed in their functioning and what their expectations of you are.
    • Make your explanations short, clear, and concise. Don't use jargon. Provide printed material if available.
    • Negotiate, rather than dictate, management and the treatment plan with the patient, as an authoritarian stance may lower compliance.
    • Offer the patient and his/her family self-help group information for added support. See www.selfhelpgroups.org.
    • Try to follow your patients right through their illness. You'll learn much more through offering continuity of care in both the inpatient and outpatient setting.
    • Be open to patient's wish to explore alternative forms of healing (like acupuncture or herbal medicine) as an adjunct to conventional care, if it enhances his or her sense of control and self-care. Check out the National Center for Complementary and Alternative Health website.
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