August 2022 Communication Tip
Respectful Communication
It was recently announced that the questions used to determine UCSF provider “Star Ratings” are being updated. Instead of asking our patients about the “Friendliness/courtesy of the care provider,” the question now is “Provider showed respect for what you say.” Not that we should only teach to the test, but this month’s column focuses on elements of communication that demonstrate respect for the patient.
Respecting our patients and their loved ones is a necessary element of effective communicationand central to a therapeutic relationship. Showing respect means valuing who the individual is-- their qualities, their worth, their personhood. Showing respect means assuring people that they matter to us.
There are lots of strategies, for sure, but here are 6 categories of skills that communicate respect.
(1) Preparing to Communicate
Taking the time before the clinical visit to prepare for the visit is key. Knowing the patient’s history, the clinical situation, the consultation question, the urgency, or the prior clinical/insurance/administrative challenges all can help communicate to a patient that they matter to you, personally and individually. This person is more than just the next slot on your busy schedule.
Setting up the ground rules for the discussion (who is a part of it, how long it will last) demonstrates respect for the patient’s needs, their privacy, and their time.
It is important to understand how patients want to be addressed (including level of formality and preferred pronouns). This part of the conversation is a good time for you to be clear how you’d like to be addressed.
Part of communicating effectively is finding out how your patient communicates and learns best (in what language? listening, visually, in written-form, etc). Do they like charts and data, stories, journal articles, websites? Can they read the AVS?
(2) Listening
The first and foremost communication skill for showing respect is listening well. (In fact, another Star Ratings question is now “Provider listened carefully to you.”).
For example, the literature is filled with advice about “active listening.” Active listening is often described as either an attitude (the clinician is listening attentively and carefully) and/or a technique (the clinician provides feedback to the patient that you are giving the patient your whole attention). Clinicians can use “conversation continuers” (such as “uh-hah” or “I see”) and non-verbal communication (such as a nod or eye-contact [on zoom or in-person]). Of course, active listening means not interrupting the patient.
Even beyond listening actively is listening “generously,” to deeply understand the patient and recognize what is true for them. Generous listening means not judging the patient or forcing them into a role that works best for you (rather than for them). No generalizing—people are individuals, not stereotypes.
(3) Silence
Communication consists of talking, listening, and the silence in between. Allowing time for silence in communication demonstrates that you are not trying to rush the patient and are allowing them the space and time to consider serious issues, including feeling difficult emotions. As has been written in this column before, what comes up after a period of silence is often more important than what was being talked about before.
(4) Responding
How we respond to patient communication can demonstrate respect. Non-verbal responses of eye contact and nods communicate attentiveness; a touch can communicate compassion. Verbal response can include the Vital Talk “NURSE” statements for responding to patient emotions. BTW, the “R” of NURSE stands for “Respecting.”
Asking patients to clarify or expand demonstrates your interest in what they have to say (and, by extension, who they are). “Please tell me more.” Similarly, clinicians can check the effectiveness of their listening by confirming their understanding of what the patient is saying. For example, you might say “What you are telling me is important, I want to make sure I understand completely. This is what I heard you say… Is that correct?”).
Do you really understand (and can you empathize with) the perspective, the beliefs, the experiences, and the feelings of your patient? Especially if you are different from patient (different races, different generations, different genders, different sexual orientations, different economics, different experiences of privilege or oppression), you typically need to work harder to understand what they are saying. Communication is cultural. Authentic curiosity and a warm invitation to say more are instrumental in effective communication across difference.
Find common ground in disagreement (again, respecting differences). When we are wrong [I’m sure more than we realize], we should show the patient the respect of apologizing.
(5) Our Notes
With Open Notes (patients able to read their clinical notes in MyChart), respectful communication extends past the clinical visit. Respect includes being sensitive to patient’s privacy and how you describe them and their health. As was said in a recent paper on quoting patients in clinical notes, “Quotes may be beneficial when it is important for the reader to know that the patient said exactly those words, but clinicians should never use quotations to ridicule a patient, express frustration or disapproval, or insinuate that the patient is untruthful (Beach. Ann Intern Med. 2021).
(6) Kindergarten Communication Skills
Lastly and as a reminder of what we all should have learned about communicating with respect in kindergarten… Be polite and be kind. Say please and thank you. Look people in the eye when you are listening and talking. Extra credit if you can maintain eye contact during the intimacy of silence.
All my best,
Mike