The demonstration of dignity and respect results in a patient’s feeling understood and accepted as a person. This is the practice of empathy, which is often confused with sympathy (27). Sympathy is an expression of one’s own feelings (“I’m sorry”). Empathy is the demonstration of an understanding of the patient’s feelings (“You must be very sad”). The confusion of medical terminology as well as the time constraints of modern hospital-care encounters can be obstacles to achieving the type of dignity and respect that results in a high degree of patient satisfaction. A number of effective tools are available to facilitate this important result. Sitting down during patient encounters greatly enhances the perception of time and caring of hospitalists on the part of patients. Eye contact and appropriate touch are demonstrations of dignity and respect, as is seeing patients fully clothed. It is important to pay attention to nonverbal communication issues with patients. An important element of how hospitalists are perceived by patients has to do with nonverbal issues such as demeanor, body posture, and verbal tone. Using a patient’s own words and addressing underlying feelings facilitates the practice of dignity and respect (28). Patients perceive statements of assured understanding as confirmation that they have been listened to. Remember the words of Sir William Osler: “Listening is unspoken caring.”
The effective transfer of information is at the core of physician/patient communication (29). Patients have the need to provide complete information to physicians to facilitate an accurate diagnosis. The physician’s role is to provide information that addresses the cognitive, behavioral, and affective needs of patients and their families concerning their illness. The discrepancy of language, time constraints, and the ability of patients to remember are all barriers to the effective transfer of information. Some useful techniques for effective information transfer include assessing a patient’s current level of understanding and asking about their self-diagnosis. Timeliness in providing results of diagnostic tests is an important issue to patients who are often waiting expectantly. Studies have shown that the majority of patients have questions about the so-called “mysteries of medicine,” related to the diagnosis, etiology, and prognosis of their illness (30).
Patients may not specifically ask these questions; however, they are present, and patient satisfaction will increase if these questions are answered. Patients have decisively indicated their desire for shared decision making regarding their health care and for patient and family control of all-important choices (26). The process of shared decision making can be facilitated by collaboration between patients and the hospitalist around goals ands plans for treatment in the hospital (31). A barrier to shared decision making is a patient/physician relationship based on a model of paternalism (“I’m the doctor, and I know best”). A more productive model for the therapeutic relationship is that of a partnership between the hospitalist and the patient, particularly in the present era of web-educated, sophisticated consumer patients.
An important tool to achieving this type of collaboration involves the approach of presenting patients and families with treatment options and then actively soliciting patient preferences. A question is whether patients will actively participate in treatment decisions and then adhere to treatment plans. This is in large part determined by the interpersonal relationship skills of the clinician and can be further facilitated with simplified regimens that have been agreed upon by the patient and the hospitalist (32).
A complete model of the hospital-care encounter provided by hospitalists has an opening and a closing. In between there is a series of moments of truth that can potentially be imbued with attentiveness, dignity and respect, effective information transfer, and shared decision making. The opening is a brief moment that will set the stage for the remainder of the encounter. Greeting patients by name and maintaining eye contact will help in establishing the early perception of being a caring and concerned clinician. It is important to close hospital encounters with a sense of hope and optimism, making sure that all of the patient’s issues have been addressed, as well as planning for the next steps.