LAS VEGAS – A quarter of patients in the United States changed health care providers last year because of communication issues yet never told their providers, according to a speaker at the Hanger Education Fair & National Meeting, here.
“Have you ever had patients drop out of your schedule and you wonder why? And you will never know, and most patients won’t tell you,” Dan O’Connell, PhD, said. If a patient doesn’t like a practitioner, “it might take a health care provider a year or two to realize ‘I haven’t seen Mr. Sanders in awhile.’ That is the way it works. Most people will not tell you to your face.”
Patients may leave a practice for any number of reasons, but learning to communicate with empathy can help build trust, making it less likely they will leave. Patients do not like to feel judged, so instead, judge the condition or behavior, O’Connell said. The practitioner should not call the patient “fat” or “lazy” but should ask him if he understands the connection between exercise or smoking, for example, to poor health. If patient think their practitioners are judgmental, they will not want to continue going to them, O’Connell said, so it is important to normalize patients’ ambivalence to change in behavior or reluctance to continue as a patient. Normalizing simply tells patients that it is ok to feel uncertain, he said.
Appropriate self-disclosure helps to build empathy, O’Connell said, but this does not include telling a patient ‘I understand how you feel,’ because in all likelihood, the practitioner does not.
“Some people might say, ‘I remember when my brother came back from Afghanistan or my mother had her leg amputated because of type 2 diabetes and I remember how she was,’ and patients tell us that gives you a lot of credibility,” he said. “But when they ask ‘what would you do if it were you’…I am not going to tell them what I would do if it were me. But I would tell them what I might consider if it were me.”
For recalcitrant patients who may not want to open up, appropriate self-disclosure can be helpful by saying something like “I don’t know what is going through your mind, but I can tell you I have dealt with a lot of guys coming back from Iraq and Afghanistan that tell me after the fact, that thinking about getting fit for something was one of the biggest decisions of their lives, so if you want to talk about this, let us know,” O’Connell said.
He said the key is not to insist on an immediate action, but rather to coax a response. In addition to normalizing ambivalent feelings and appropriate self-disclosure, empathetic responses also may include reflecting back what the patient is saying; building a sense of partnership; and highlighting and amplifying the patient’s progress, O’Connell said. – by Carey Cowles
For more information:
O’Connell D. Clinician-patient communication to enhance health outcomes. Presented at: Hanger Education Fair & National Meeting. Feb. 3-7, 2014, Las Vegas.
Disclosure: O’Connell has no relevant financial disclosures.