How to Increase Patient Satisfaction by Setting Realistic Expectations
COMMUNICATION 101: HOW TO TALK TO YOUR PATIENTS ABOUT THEIR KNEE REPLACEMENT SURGERY
A 44-year-old active woman has just been diagnosed with knee osteoarthritis by her physician. Tearyeyed,she doesn’t really comprehend what her condition entails and is convinced that after her total knee replacement (TKR) surgery, she will never be able to walk well again. In fact, she is certain that she will be bedridden after the procedure.
How might her physician effectively communicate that even though she needs surgery, her mobility will not be completely eliminated? She is upset and possibly not thinking clearly. Is there an approach her physician might take to convey information that appropriately sets outcome expectations?
WHY CLEAR COMMUNICATION IS KEY
Research has shown that effective communication between physicians and patients is significant in helping their patients understand the conditions that they are experiencing.1
It can also be important in helping patients understand the next steps to deal with those conditions—be it surgical or otherwise.1
The better that physicians communicate with their patients about what they can expect regarding the procedure, their recovery plan, the pain levels that may face and more, the better the patient may understand what they are about to experience.
As noted in a 2010 review in The Oschner Journal, improved or increased communication between a physician and patient can galvanize patients to not only be involved in his or her own care, but also to stick with the recommended recovery plan.1
The study also notes that enhanced communication between the two also helps the physician identify better the patients needs, perceptions and expectations.1
So what have other studies found about how to communicate with patients?
Here are several approaches that researchers say are effective in getting the right message to patients.
USE SIMPLE LANGUAGE:
While physicians may already avoid overloading conversations with high-level medical jargon their patients may not understand, they may not know to also avoid euphemisms when sharing information. When physicians characterize pain as “discomfort” or “difficulty” rather than using the word “pain” for example, it can minimize what the patient will actually experience and confuse future expectations. As a 2005 Journal of the American Osteopathic Association (JAOA) study reports, “euphemisms may soften the delivery of sad information but can be extremely misleading and create confusion.”2
REMEMBER YOUR BODY LANGUAGE:
“From obtaining the patient’s medical history to conveying a treatment plan, the physician’s relationship with his patient is built on effective communication,” notes the JAOA study. “In these encounters, both verbal and nonverbal forms of communication constitute this essential feature of medical practice.”2
So when reviewing information that can be troubling for a patient, body language and facial expressions will leave a lasting memory with them.3 Physicians can show empathy via non-verbal communication by looking at them when they speak, listening to them and other similar actions (holding eye contact, nodding in response to queries or concerns, etc.). This can help convey critical information and using attentive listening skills can be as important as the facts being conveyed.
Surgery is often upsetting for patients and they may need to know that their physician understands that feeling. “Patients often regard their doctors as one of their most important sources of psychological support. Empathy is one of the most powerful ways of providing this support to reduce patients’ feelings of isolation and validating their feelings or thoughts as normal and to be expected.”4
BUILD A RELATIONSHIP
Using a patient’s name, looking them in the eyes while sharing information and listening are a few habits that may help a physician build a trusting relationship with their patient. Also, calmly using “I” to give requests may help rather than “You” which can come across as accusatory.5 (“After the surgery, I want you to…”).
GIVE IT TIME:
When laying out key information for patients, it is important to give them time to not only process that information but to convey emotions and concerns around it. The JAOA article noted “that physicians typically wait only 23 seconds after a patient begins describing his chief complaint before interrupting and redirecting the discussion. Such premature redirection can lead to late-arising concerns and missed opportunities to gather important data.”5
- Fong Ha., J., Surg Anat, D., Longnecker, N., (Spring 2010) Nancy Longnecker Doctor-Patient Communication: A Review (p. 38-39) The Oscher Journal
- Travaline, J.M., Ruchinskas, R., D’Alonzo Jr., G.E. (January 2005) Patient-Physician Communication:Why and How (p. 16) Journal of the American Osteopathic Association
- Lindsley, I., Woodhead, S., Micallef, C., Agius, M. (2015) The Concept of Body Language in the Medical Consultation, Psychiatria Danubina
- Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES—a six-step protocol for delivering bad news: application to the patient with cancer. (p. 307) Oncologist. 2000;5(4):302–311.
- Anita G. (March 2015) The Importance of Good Communication in Treating Patients’ Pain (p. 266) AMA Journal of Ethics