What Constitutes Poor Communication?
“First, on one level, poor communication skills are inefficient in talking with patients,” says Steven Pantilat, MD, SHM president. “So, I think it makes your work harder.”
Some examples of communication inefficiency (or ineffectiveness) for a clinician include:2,4,5,6-8
- Lacking the ability to articulate ideas adequately;
- Transferring insufficient information between the provider and the patient, including inadequate elicitation of key facts from the patient;
- Failing to assess the current level of information before supplying new information;
- Taking too much or too little time in regard to the needs of the situation;
- Overusing medical terms and not recognizing when patients cannot decipher them;
- Using little eye contact and appropriate touch;
- Using closed body language;
- Being inattentive to the patient’s body language;
- Using inappropriately open or closed questions when the circumstance calls for the opposite;
- Not using a patient’s own words when doing so would be helpful to diagnosis or management;
- Exhibiting a lack of empathy, compassion, understanding, and support;
- Being inattentive or insensitive to a patient’s feelings;
- Being inattentive to cognitive, psychosocial, and affective needs;
- Disregarding the need for shared decision-making;
- Lacking the skill for or failing to use active listening;
- Failing to use timeliness in feedback or reporting test results;
- Neglecting to seek feedback regarding whether cultural, regional, or language/accent differences (both the doctor’s and the patient’s) impede communication; or
- Using an angry, anxious, or dominant tone of voice.
The second effect of poor communication that Dr. Pantilat cites is that “patients are less satisfied with their care and … to the extent that the relationship with the physician actually has an impact on how patients feel, patients may not ‘get better,’ ” he says. “And I don’t mean, for instance, that with a patient who has pneumonia, their pneumonia won’t get better; but there are a lot of other conditions where feeling like someone is listening to you, feeling like you’ve been heard, feeling like someone has communicated clearly can make you feel better.”7 (See also The Hospitalist, “Patient Satisfaction: The Hospitalist’s Role,” July/August 2005.)8
Inpatient communication tends to be a different kind of communication than that used in some other medical settings—more intense in a shorter time period and conducted between people who are strangers at the time of the patient’s admission. “It’s not that the stakes are higher, but it’s actually just the intensity of it is different,” says Arpana Vidyarthi, MD, a hospitalist who is the director of quality inpatient medicine at the University of California, San Francisco Medical Center.
“Time constraints are a major reason for poor communication skills happening,” says Dr. Trowbridge, whose hospitalist practice involves 60% clinical work with the Maine Hospitalist Group and 40% administrative work involving medical students and faculty development with the Department of Medicine at Maine Medical Center. “Relationships are really what many physicians most enjoy in medicine: with colleagues, … with patients, … with families. Having poor communication skills has a huge impact on job satisfaction and then personal satisfaction,” in many instances because of the heightened levels of stress.
“People are not here because they’re trying to get their lipids down,” says Dr. Vidyarthi. “They’re here because they’re [acutely ill]. When people are very, very ill, or when they’re having an intense experience, they tend to hang on every word.”