Thread by @DocMCohen

As both a health care provider and a lover of words, I have spent a LOT of time over the yrs thinking about talking to patients. Primarily how to shape my words so as to communicate my meaning most effectively.

Please join me in a

#PatientCommunication #TWEETORIAL /1

First, it’s about listening, specifically listening to the words pts use to describe their health/bodies. I consciously take note of the words pts use and reflect those words back, eg: “this sort of condition can cause the feeling you’re having in your waterworks.” /2

I know some HCPs prefer anatomical terms for unambiguity, and my response to that is: use both!

Combining the pts term’s with clinical terms in a fluid way takes some practice, but is well worth it: “a stone in your kidney can make your waterworks feel very irritated.” /3

Next is repetition. I deliver the same message at least 3 times in different ways, all the while paying attention to see if one particular way seems to resonate better with my pt. If so, I can focus on that phrasing or try to expand on it. /4

It can be hard to know if a pt got the message I was trying to communicate, so this is again where repetition with variation is key.

Having long-term relationships in my family practice definitely gives me an advantage over consultants & acute care docs in that regard. /5

But repetition is still useful in a short-term relationship with a pt. It’s well known that people have a hard time receiving new info in times of stress. It should be considered a huge clinical error to only explain a new diagnosis, symptom or treatment once in a visit. /6

Yes, explaining things, repeating and looking for signs of understanding to expand on in further communication takes time in a visit.

There are no shortcuts to effective communication, just the smoothness of skill that develops with practice. /7

But the benefits are huge. Knowledge empowers pt autonomy, which is a bedrock principle of health care. Good communication engenders trust in the therapeutic relationship. Use of health care resources are more effective when communication is solid. Pt outcomes are better. /8

Given the number of times I’ve been told I’m the FIRST doctor to FINALLY explain something to a pt, I would say those of us who practice good communication in clinical medicine are actually doing the work some of our colleagues are supposed to be doing... but aren’t. /9

Finally, I have thought a lot about the words I use during clinical exams & procedures.

Words can heighten the sense of loss of control during an uncomfortable/vulnerable experience or they can reduce it.

Asking for consent and warning about what’s to come are essential. /10

If a pt's having a tough time, I can remind them I’ll stop if they need. I can count down to being done. I can ask distracting questions or sneak in repetition of something I said earlier. Obviously not every procedural moment can have split focus like that, but many can. /11

I humbly request all HCPs stop using the word “relax”. When has someone saying “relax” to you ever worked to get you to unclench, either physically or mentally?

It has a semi-judgemental connotation that doesn’t work well in a clinical context. Just drop it. /12

If someone is clenching ask them to loosen that specific muscle. Or give them a visualization. I ask pts who are tensing during a pelvic exam to imagine their bum is sinking or melting into the bed. Or ask them to take a deep breath. All much more effective than “relax”. /13

HCPs, please think about the words you use during intimate exams.

You can come up with something better than "open your legs", really you can, you're smart and I believe in you. /14

My usual words in a pelvic exam:

I introduce touching the knees, then I touch them lightly and say, "pls let your knees flop apart". Then I continue to introduce everything I'm about to do and describe what I'm doing. I try to give a running estimate how much time is left. /15

I was once scolded in med school for talking too much during pelvic exam. To that I say: bullshit.

My words might not be perfect and I'm sure there's room for improvement, but cold silence is FAR worse. /16

The bottom line for communication is to think deeply about 1) how the pt is receiving your message and 2) what would make them more likely to get your message in the way you’re intending it.

This is definitely an undertaught skill in #MedEd, but is SO important to have.

FIN