MSHQ 111 : 6 Tips For Improving Patient Communication (The 6th is Key!)

Session 111

Session 111

Allison and Ryan discuss how to improve patient communication which will ultimately lead to better patient outcomes, improved physician satisfaction and so much more!

Ryan and Allison are taking another spin in this episode as they talk more about doctor-patient communication. Communication is probably the most important part of healthcare and in building relationships with your patients. Note that a better understanding about your patients leads to better job satisfaction, patient satisfaction, and the outcome as well.

And even as a premed, you can learn these skills now. The better communication with your patients, the better you will be at it when you set foot into medical school and so on.

This episode has been sparked by a recent article in The New York Times called Doctor, Shut Up and Listen which was written by Dr. Nirmal Joshi.

He quotes about a lot of studies that talk about communication breakdown and what that leads to. Additionally, here are some interesting facts and figures that were also mentioned in the article::

  • In The Joint Commission, they found that communication failure rather than any lack of technical skills or understanding, the communication failure was at the root of over 70% serious adverse health outcomes in hospitals.
  • Two out of three patients leaving the hospital not knowing their diagnosis.
  • 60% of cases where patients walk away from a doctor’s visit not understanding what they’re supposed to do, instructions, counselling, etc.

Considering these alarming statistics and the huge, huge impact communication has on improving patient care, Ryan and Allison have laid out six tips on how to improve your communication with patients to better understand and better speak to them.

6 Tips for Better Communication with Your Patients

Introduce yourself.

  • Only 1 in 4 doctors don’t introduce themselves.
  • Assumed authority is not cool.
  • Acknowledging not just the patient but also the family members around
  • How to introduce yourself to the patients
  • Saying your name using just your first name vs. adding “Dr.” to your name (What are your thoughts? Leave your comments below.)
  • Identifying yourself clearly as the member on the team

Speak in layman’s terms

  • Actively translate technical, medical terms into simpler terms

Check if your patients understood you.

  • The “teach back” method

Be adaptable.

  • Slow down and adapt to the situation.
  • Attend to other needs/questions of your patients.
  • Show empathy and share a piece of your time with the patient if they threw you a curveball.

Gain a better understanding of what’s going on their life

  • Interacting with a noncompliant patient
  • Take the time to know who they are and their life in general.

Just be honest.

  • Patients want the truth. Don’t beat around the bush.
  • Be honest to yourself in terms of how you deal with your patients.
  • Be honest when you don’t know something.

One more bonus tip!

Communicate effectively with your team.

 

The New York Times article written by Dr. Nirmal Joshi, Doctor, Shut Up and Listen

Episode 66: Physician, Paralympic Athlete and So Much More

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Transcript

Dr. Ryan Gray: The Premed Years, session number 111.

Hello and welcome to the Medical School Headquarters Podcast; where we believe that collaboration, not competition, is key to your premed success. I’m your host, Dr. Ryan Gray and in this podcast we share with you stories, encouragement and information that you need to know to help guide you on your path to becoming a physician.

Welcome back to the show, if this is not your first time; if this is your first time, welcome. This is our first podcast of 2015, so Happy New Year to everybody, I hope everybody had a happy and healthy holiday season. I have in the studio, also known as our basement with me, Allison.

Dr. Allison Gray: Hello. I was going to say good morning, but it’s really not.

Dr. Ryan Gray: It’s not morning. It’s not morning. It might be morning for people that are listening.

Dr. Allison Gray: That’s true. Good evening, good afternoon, good morning.

Dr. Ryan Gray: You could do the Good Morning Vietnam like Robin Williams used to do.

Dr. Allison Gray: Oh, that’s sad. I don’t remember how it used to sound actually anyway. We’re like dating ourselves and we’re not that old actually.

Dr. Ryan Gray: Yeah, anyway. So in this podcast we’re going to take a little spin again. So sometimes Allison and I talk premed stuff, sometimes we have interviews about premed stuff. This time we’re going to take a little spin and talk more about doctor / patient communication. So not necessarily premed stuff, but one of those very important topics that I think when you master- if you can truly master communicating; but when you gain a better understanding of communicating with patients, I think your job satisfaction increases.

Dr. Allison Gray: Definitely.

Dr. Ryan Gray: Hopefully patient satisfaction increases.

Dr. Allison Gray: Yeah, and their care.

Dr. Ryan Gray: Outcomes increase.

Dr. Allison Gray: Yeah and out there as a premed, you can start these skills- learning these skills now. You can start now, and the more you dedicate yourself to good communication with your patients, the better and better you will be at it when you set foot in medical school and then beyond.

Dr. Ryan Gray: And this conversation was sparked by a recent article- and recent meaning yesterday, two days ago. A recent article in the New York Times titled, ‘Doctor, Shut Up and Listen.’ Meaning, ‘Hey you doctor, shut up and listen to me,’ from the patient. And it’s written by a physician, is it not?

Dr. Allison Gray: Mm hmm.

Statistics

Dr. Ryan Gray: So it’s an interesting perspective. And in this article, it’s Dr. Joshi- I think that’s how you pronounce the J-O-S-H-I. Joshi? Anyway. In the article he quotes a lot of different studies that talk about communication breakdown and what that leads to. And one of these, the Joint Commission which is- if you work in a hospital, you will know what the Joint Commission is. They found that communication failure, rather than any kind of lack of technical skills or understanding, the communication failure was at the root of over 70% of serious adverse health outcomes in hospitals. Now, that’s interesting. I would have preferred a next to sentence to that, to show the dollar amount. What did that cost tax payers? What did that cost hospitals? How many deaths were that?

Dr. Allison Gray: Were there.

Dr. Ryan Gray: How many deaths were there? Anyway. So it’s a huge number. And it talks about the percentage of patients that walk away from a doctor’s visit not understanding what just happened.

Dr. Allison Gray: Yeah, that was a staggering statistic as well.

Dr. Ryan Gray: And so-

Dr. Allison Gray: Two out of three.

Dr. Ryan Gray: Yeah. Two out of three didn’t understand the diagnosis leaving the-

Dr. Allison Gray: Leaving the hospital, right?

Dr. Ryan Gray: The hospital.

Dr. Allison Gray: Yeah, but over 60% of cases- in over 60%, patients left the doctor’s office without understanding what they were supposed to do, their instructions, counseling, et cetera.

Dr. Ryan Gray: Right. So Allison and I are going to lay out for you six or so- we always seem to add stuff at the end. Six tips to help you improve on your communication with patients. And this is you as a premed, you as a medical student, you as a resident, an attending; anywhere where you are, this will help you better understand and better speak to patients.

Dr. Allison Gray: Yes, and I think that this is a skill that you can never, ever get good enough at. You can’t ever get complacent about your communication skills, and you can’t ever decide in my humble opinion that you’re a great communicator so fine, you don’t need to practice. It’s one of those things that you always- especially with the changing nature of medicine and the world in which we operate and practice. You have to be able to constantly be bettering your communication skills, so start early and just keep on at it. And one of the nice things in this article is at some point they mention that being a good communicator should not just be an extra bonus for a physician, that you cannot practice good medicine without being a good communicator, without having a good bedside manner.

Dr. Ryan Gray: Yeah, I agree.

Dr. Allison Gray: So this is like seriously important stuff here.

Dr. Ryan Gray: Yeah, so take notes. But not if you’re driving.

Dr. Allison Gray: Right we don’t sponsor that or endorse that.

Dr. Ryan Gray: Condone that.

Dr. Allison Gray: That’s the word I was looking for.

Dr. Ryan Gray: Yes. So let’s start off- the first one here that we have is so basic, yet this article points that only one in four doctors do it.

Dr. Allison Gray: Yeah, which is so crazy to me. I mean, if you walk into an AT&T store, and you walk up-

Dr. Ryan Gray: We didn’t say what it is yet.

Dr. Allison Gray: Okay, sorry you’re right. Say it first.

Dr. Ryan Gray: We didn’t say what it is.

Dr. Allison Gray: It’s the no context thing. I think everyone’s in my brain and they’re with me.

Introduce Yourself

Dr. Ryan Gray: So one in four doctors- or three out of four I should say, don’t introduce themselves.

Dr. Allison Gray: Yeah, crazy. Loco. Totally nuts.

Dr. Ryan Gray: Yeah.

Dr. Allison Gray: So I was going to say if you go into like a phone store, or a retail store, and you walk up to a customer service person and you ask for help, you might just say, ‘Hi.’ But if there’s not kind of interaction, I mean it’s not kind of the- I mean it’s a little awkward, right? I mean I think if you go into a store and you say, ‘Where are the phones?’ Or, ‘Where is this?’ It’s kind of rude, right? I mean I think in a lot of places if you’re out shopping for something, if you’re out interacting with another person, if you’re in a grocery store-

Dr. Ryan Gray: But you don’t walk up to the sales person and say, ‘Hi, I’m Ryan. I’m looking for phones.’

Dr. Allison Gray: No, but you know what? Maybe you should. And when people-

Dr. Ryan Gray: Or, ‘Hi I’m Dr. Gray.’

Dr. Allison Gray: Well yeah, that would just be weird. That would be awkward. But no, my point is that- and you talk about this too, about how in certain parts in the country in terms of customer service people are much nicer and much more friendly and particularly in certain areas like maybe the northeast where we live it’s not always the case. So my point is in places where you’re not taking your clothes off and being examined and having your body parts on display for people; in just the regular kind of world where people live and work in, people typically introduce themselves. So how is it that in medicine, which is one of the most vulnerable places that a patient can put themselves in, in terms of being in a gown and naked and in a doctor’s office meeting someone they’ve never met before or in a hospital no less. When they’re admitted to a hospital with a scary freaking set of symptoms and illness, and then somebody enters the room and doesn’t even tell them who they are.

Dr. Ryan Gray: Yeah, and starts touching them.

Dr. Allison Gray: Exactly, that’s what I’m saying. That’s insane.

Dr. Ryan Gray: What’s the first thing that your server says when they walk up to you at a restaurant?

Dr. Allison Gray: “Hi, I’m so-and-so and I’ll be taking care of you tonight.”

Dr. Ryan Gray: Yeah.

Dr. Allison Gray: Right. Oh well actually on a very quick side note, I was at a 99 recently, a 99 restaurant- I don’t know if you all have that in wherever you are in the country, and the woman said to me, ‘So is anybody ordering here?’ It’s like the most awkward line ever. But that’s kind of like how it must be for patients sometimes. You’re admitted to the hospital, someone walks in and is sort of just like, ‘Oh I’m going to examine your belly now.’

Dr. Ryan Gray: Yeah.

Dr. Allison Gray: Like excuse me? What?

Dr. Ryan Gray: And the assumption is I’m wearing a white coat, I can do whatever I want.

Dr. Allison Gray: Right, exactly. It’s that assumed authority that’s assumed that- yeah. That you get to just embody this person who can just walk into a room and do that, and that’s not cool. That’s not right.

Dr. Ryan Gray: So one of the other big faux pas is you walk into a room, and the patient- if it’s in a hospital, the patient has family members or friends visiting, and you go straight to the patient and you start talking to them and examining them, possibly interrupting a conversation that may have been going on, and you don’t acknowledge anybody else there.

Dr. Allison Gray: Right and what if the patient’s in there and their crazy uncle is also in the room and they don’t want to be examined in front of their crazy uncle. I mean, and it floors me when this happens. It makes me- it makes me as a physician feel so uncomfortable when I’ve seen other healthcare practitioners do this. When they- as you said, walk into the room and there are all these people. You know, you’ve met the patient and maybe the patient’s wife or husband, significant other, whatever they may be, you know just the two of them but then all of a sudden you come back and there are all these other people and it’s like they’re part of the wall. You can’t do that. I mean it’s-

Dr. Ryan Gray: I think this is one key point for premeds. When you’re shadowing, if the physician that you’re shadowing doesn’t introduce you to the patients, I wouldn’t necessarily jump in and introduce yourself right away. After that first patient or two, see what the physician that you’re shadowing does. And then when you leave a room, say, “You know I saw the patient or the patient’s family looking at me like who am I? Do you mind if I introduce myself or can you introduce me as a student shadow or whatever it may be, to get rid of some of that awkwardness?”

Dr. Allison Gray: Yeah, I’d agree with that. You know in thinking back, I used to just speak up, and maybe that’s just me, my nature. I just very quietly- and not to interrupt the flow of conversation or anything, but as maybe the physician would come in and say, “Hi, how are you doing?” And I would just say, “Hi, I’m Allison, I’m a medical student or I’m a-” I don’t know, whatever, premed. I don’t remember what I used to say at the time, that’s why I’m saying whatever.

Dr. Ryan Gray: Student doctor.

Dr. Allison Gray: Yeah, “Do you mind?” Or, “I’m working with so-and-so today, do you mind if I’m here?” And usually it was like two seconds worth of conversation, didn’t interrupt anything, but yeah. I think your point is well taken that sometimes the physician- it might sort of interrupt their flow and it’s a good thing to ask ahead of time.

Dr. Ryan Gray: Yeah.

Dr. Allison Gray: Yeah, because no one wants a random person in the room, that’s also such an awkward thing and everybody feels uncomfortable because they’re looking around, who is this person, and then you can’t focus on what you’re there to do. Yeah.

Dr. Ryan Gray: So one other quick point here, and I think we’ve mentioned it before but we’ll talk about it again. Is how you introduce yourself to patients. And Allison and I kind of differ on this a little bit. And maybe it’s just the environment that I’m in, in a military environment, where it’s just a little bit different. But I think in the civilian world if I go back to that, I would probably do the same thing now. I don’t introduce myself to the patients as Dr. Gray. I say, “Hi, I’m Ryan.” And I’ve read some stuff that that immediately puts the patient at ease because now all of a sudden they think on a human basis they’re on the same level as you. Obviously you’re still the doctor and they’re still the patient, but you are humans looking at each other.

Dr. Allison Gray: And I just take a different approach. So part of why I think it’s important to acknowledge who you are to say, “Hi, I’m Dr. So-and-So,” is not because you’re trying to have anybody bow down to you, blah, blah, blah. No, it’s because in a typical academic medical center when a patient is admitted in a teaching hospital, they are going to meet- I’m going to make this up but probably- I mean they’re going to meet like between twenty and fifty people, I mean easy. So- and it depends on where you are, but think about. They come into the ER they’re going to meet a whole series of people in there, then they come upstairs, they’re going to meet a whole series of people in there. They’ll meet the intern, the residents, the fellow maybe, the attending. They’ll meet different nurses depending on day shift and night shift, they might need a nursing supervisor, they’ll meet a case manager, a physical therapist, occupational therapist, speech language pathologist. They’ll meet a social worker- I mean the list goes on and on and on. So how-

Dr. Ryan Gray: So what does adding ‘Doctor’ to your introduction-?

Dr. Allison Gray: Because part of it is- and by the way, the other thing we should mention is that everybody wears a white coat now. So the symbol that we’ve-

Dr. Ryan Gray: So what about the physical therapist who’s a doctor of physical therapy? Do they introduce themselves as Doctor?

Dr. Allison Gray: No but that’s a whole other conversation for another day. That’s a whole different thing.

Dr. Ryan Gray: Or the nurse that’s a doctor?

Dr. Allison Gray: But- they may have a PhD.

Dr. Ryan Gray: Or a speech therapist that’s a doctor.

Dr. Allison Gray: Yeah, but that’s a totally different- that’s taking it out of context. And that’s a totally different podcast. I’m sorry, that is a totally different episode, because- and I have family who- PhDs in the family so it’s a heated discussion and whatnot. But not, my point is because you’re trying to do everything you can to help that patient understand your role. So it’s not to say I am Dr. Blah Blah Blah, because I’m so important. It’s I am Dr. Gray, I’m your intern here, I’m your resident, whatever I may be.

Dr. Ryan Gray: Hi I’m Ryan, I’m your resident.

Dr. Allison Gray: Okay, that’s fine. But so the way though that I think- you know you talked about just a minute ago how you think you should say Ryan because that allows you and the patient to be on the same level, and it immediately fosters this feeling of just being able- of trust. My attitude about that is that the way that you develop trust and rapport and all that is with what you say, your behavior, your body language, your rapport, all of that. So just adding ‘Doctor,’ to me that’s not what’s important, it’s everything that follows it. And I also think that when a patient, in my point of view- again, humble opinion here, when if I were to be admitted to a hospital and I were really sick with something, and if I were scared, which I most likely would be in that scenario, I would want to know who is the individual who’s responsible for me who’s going to make me better, who’s going to help see me through this. And the person responsible at the end of the day is going to be the physician; the leader of the team, right? Now everybody plays an extremely important role on that team, but the leader of your team is likely going to be a physician in this makeup- in this world that we live in. So you want to be able to identify, ‘Well who do I call if I get really scared and I don’t know what’s going on, and I need questions answered?’ I think it’s important to identify yourself as clearly as who you are as a member of that team. So if you’re Dr. So-and-So, then you’re Dr. So-and-So. You’re smiling at me with this snarky look.

Dr. Ryan Gray: I don’t think you’ve proven your argument.

Dr. Allison Gray: You just disagree with me, it has nothing to do with proof, this is all opinion here.

Dr. Ryan Gray: So for you listening, tell us what you think. Go to www.MedicalSchoolHQ.net/111 for Session 111, and tell us what you think.

Dr. Allison Gray: And by the way, I should add that some people might feel completely differently. Like I mean- and people have said that sometimes a physician has no idea what’s going on, it’s the nurse who is able to actually carry the patient through and alert the physician when something is wrong, and that’s 100% true. So some people might feel like, ‘Well I just want to know who my nurse is, I don’t really care about anybody else.’ So maybe what I’m saying is total hogwash, but that’s just a certain perspective that I’ve taken and that I think makes sense to me, but this is all- again, this is all- the important thing here, the punchline I think, it really doesn’t matter how, like what the suffix or the prefix, or whatever your title; what matters is that you introduce yourself.

Dr. Ryan Gray: There you go, I’ll take it.

Dr. Allison Gray: Okay.

Dr. Ryan Gray: Alright. Moving on. Number two. Speak in layman’s terms. So this is a huge one because the medical field is built upon our special language; our medical knowledge built around mostly Latin words and everything is super long and has all of these prefixes and suffixes, and patients don’t understand it. And sometimes it’s good that they don’t understand when you’re discussing things, and then you can kind of put it down in layman’s terms. But for the most part, almost all the time, you’re going to need to actively translate- you know how Google translates for everything on the Internet. You’re going to need to Google translate in your head, that you’re thinking of hypertension in your head. You’re going to have to spit out of your mouth, ‘high blood pressure.’ Or hyperlipidemia comes out as ‘high cholesterol.’ Or whatever it may be, there’s that disconnect there that again, we talk about patients and their anxiety levels, they’re in the hospital, they’re in the doctor’s office, what’s wrong with me? Am I dying? What’s going on? And you start spouting off all of these super technical medical terms, it’s just going to make them more anxious.

Dr. Allison Gray: Right, exactly. And it does not help with feeling like you can trust the person. Like they understand you, like they’re on the same level as you. Yeah. That’s a definite one.

Ensure the Patient’s Understanding

Dr. Ryan Gray: Yeah, I think that’s easy. Simple. Alright the next one is an interesting one. And it’s something that- I think you and I saw this kind of around the same time about asking patients if they understand you. So if I talk to a patient who comes in and we’re starting them off on a new blood pressure medication. That they’ve seen me and their blood pressure is just not going down and I say, “Okay Mr. Smith, you need to start blood pressure medications. What you’re going to do is you’re going to take this medication for a couple weeks, I’m going to have to have you come back in, we’re going to recheck some labs, and see if the medication is doing okay, recheck your blood pressure, and then we’ll go from there.” As soon as I’m done saying that, and I say, “Do you understand me?” What’s the patient going to do?

Dr. Allison Gray: “Yup.”

Dr. Ryan Gray: “Yup.” Good, my job is done as a doctor, right? The patient has said they understand me, I’m going to write the script, they’re going to go to the pharmacy and everything’s going to be good, I’m going to see them in two weeks because they said they understand me.

Dr. Allison Gray: Yeah, and it could be even more fancy sort of- ‘Does everything I said make sense? Does this make sense to you?’ Because ‘Do you understand’ is sort of condescending a little bit. But the point is, yeah that the response to that is always going to be ‘yes,’ and why is that?

Dr. Ryan Gray: Because you’re the doctor and I don’t want to seem like I don’t understand you because then I might feel dumb.

Dr. Allison Gray: Yeah, and this has been studied; they looked at this.

Dr. Ryan Gray: I don’t want to be the only patient that doesn’t understand what you’re telling me.

Dr. Allison Gray: Right and feel like then you’re wasting the physician’s time because then you have to sit there and they have to sit here and explain it to me again and not only am I sick but I’m dumb, like you said. Yeah, so it’s not a good idea- it’s a great intention to try to make sure that your patient is understanding you, but it’s not the best way to go about it.

Dr. Ryan Gray: Yeah, so there’s this teaching method, I guess you would call it. Or this understanding method, a technique for teaching patients, called the Teach-Back. So you tell a patient you’re going to start this new medication, you’re going to come back in a couple weeks, you’re going to do some labs, we’re going to recheck some blood pressures, and we’re going to see if everything is working well. Instead of saying, “Do you understand everything I’m saying?” Or whatever you said, the non- the better way of saying it. The one other way of saying that is, “When you get home, what are you going to do?” Or, “Can you repeat back to me in your own words what I just explained to you?” And it’s a totally different way of doing it. And on the show notes page, www.MedicalSchoolHQ.net/111, we’ll have a YouTube video showing this technique; it’s a pretty good video that shows this technique.

Dr. Allison Gray: And you might think that this is just going to result in more time, and you don’t have time to go through this and see if the patient is understanding and, look you only have fifteen minutes and you have to do what you have to do and you just hope and cross your fingers and hope for the best. But the reality is that if they don’t follow the instructions, not only is their care affected but it may result in delays and problems in that- hey look they’re calling you two days later because they don’t remember what you told them or they don’t understand. So it’s actually going to result in a lot more time.

Dr. Ryan Gray: And then you’re another stat on that poor communication leading to 70% of adverse health outcomes.

Dr. Allison Gray: Yeah.

Be Adaptable

Dr. Ryan Gray: Alright, so the next one here is being adaptable. Being able to slow down, being able to adapt to the situation. So as a physician- again we talk a lot about the hospital setting because things move a lot faster in the hospital setting, there’s a lot more to do when you’re a resident and medical student. You typically enter a room with an agenda, right? You go in, you say, “I need to palpate this belly, this person had some abdominal surgery yesterday, I just need to push on the belly for a minute to make sure it’s not tense and they’re not painful and then walk out.” What happens if that patient throws you a curveball?

Dr. Allison Gray: Right. Have you allotted time for that? What do you do?

Dr. Ryan Gray: Yeah, so you walk in, you push on the belly, it’s not very tense but the patient goes, “You know what? I’m having this pain in my leg.” And you’re like, “Okay, that’s fine whatever. I’m just worried about your belly.”

Dr. Allison Gray: Yeah.

Dr. Ryan Gray: What do you do then?

Dr. Allison Gray: Well I mean it depends what kind of a physician are you? If you’re a good one then you have to attend to it. It’s the same kind of thing like you’re leaving the room and you just asked sort of that last question, “Is there anything else that you need to tell me or everything is okay?” “Oh, by the way I’ve been having really severe chest pain whenever I go up the stairs.” Same kind of thing, you can’t just let it go. So what do you do-

Dr. Ryan Gray: What if you don’t have time?

Dr. Allison Gray: Well you have to be adaptable. You have to figure out how to change your timetable. So one of the things that this article talked about, this piece, he talked about how the- in one of these, what was it, I guess it was an encounter. So a physician- they mapped all this out and there was an encounter where a patient said, “I’ve just lost somebody I really, really care about.” And the next line out of the physician’s mouth- and I’m sure they didn’t say about it, I’m sure they said, “I just lost my mom,” or whatever it was. But they said, “How is your abdominal pain?” So it was like a complete departure. Like how do you go from saying- just to another human being, “I just lost my mom,” and being tearful and crying and being absolutely just devastated and then the next words out of the person’s mouth across from you are, “How is your belly pain?”

Dr. Ryan Gray: Yeah.

Dr. Allison Gray: It’s like, what?

Dr. Ryan Gray: I can’t bill for you losing your mom, so I’m not even going to bother with that.

Dr. Allison Gray: Right. So how did we get there? So that physician probably- if we are thinking positively, optimistically, that physician probably doesn’t not care, I’m sure that they care on some level that another human being across from them is crying and devastated. They probably didn’t know what to do because in their timetable they had fifteen minutes to talk with this patient, and the patient came up with like you said, a curveball, something completely unexpected and they didn’t know what to do, they didn’t have time, so they just tried to check off their checkboxes of the things they had to do before leaving the room. Instead, there are other ways to handle that. How about, ‘You know what, I am so sorry to hear about this, and I want to take the time to sit with you and hear from you and see what I can do to help you. Can I get your nurse-‘ or if you’re in the outpatient setting, ‘can I go grab someone and have them sit with you and get you some water and sit with a few minutes, and I will come back as soon as I can. I have to go and do something urgently and I can’t get around it, but I will be back and if you can wait here I want to hear more about this.’ So what about something like that?

Dr. Ryan Gray: Yeah, that works.

Dr. Allison Gray: And maybe it won’t but I mean it’s at least acknowledging- you know if you don’t have empathy, and that’s the problem. You may have wonderful empathy, you may have rockstar empathy, but if you don’t take the time- if you sacrifice the patient because of your timetable and your agenda, then you don’t have any empathy. Or at least you’re not demonstrating it.

Dr. Ryan Gray: Yeah. Okay. So be adaptable, slow down.

Dr. Allison Gray: Yeah and as a resident, as a premed if you’re shadowing, what if somebody grabs you when you’re a premed. I remember being in a women’s clinic and people asking me in tears if they had done the right thing, and with no training I was supposed to rush off and get vitals but as a human being how can you not sit there and say, ‘Well okay I’m just going to sit down with this person for a little bit.’ Now you don’t have that luxury necessarily as a medical student, certainly not then as a resident and a busy attending physician. So instead of just delegating it or cutting off the time, try to figure it out; think outside the box, be adaptable, try to carve out time elsewhere and remember that it’s always about the patient at the end of the day. It’s not about- I mean yes, getting home to your family and all of your other personal obligations are so important too, but if- you’re kind of completely missing the point if you sell the patient short in terms of your caring for them.

Dig Deeper

Dr. Ryan Gray: Yeah. So the next one we have on here is dig a little bit deeper, try to gain a better understanding of what’s going on in their life. And that communication will profoundly impact your ability to care for your patient. The understanding of what’s going on in their life. We were doing a mock interview last night for our academy members, and the question I asked the member Robert, I asked him as an admissions committee member- I was pretending to be the admissions committee member interviewing him. I asked him, “You’re a medical student, and the patient you’re about to see has been known to be a noncompliant patient. How do you interact with that patient and show them, tell them, that they’re noncompliance is impacting their care or whatever it may be. What’s your interaction with that patient who’s noncompliant?” And his response to me was the perfect response. He said, “Well first of all I’d try to understand why they are being noncompliant.” And he hit it right on the head. Figure out why they’re being noncompliant. You’ll have patients that can’t afford their medications and so their blood pressure medication that they’re supposed to take once a day, they take every other day because they’re trying to space out their medications because they don’t have enough money to take it every day. Or whatever it may be. And so asking those questions about, ‘what’s going on in your life? What- do you have any life stresses right now? Do you have any family issues? Do you have any work issues? What’s going on that may be causing this other stuff that you’re seeing me for?’

Dr. Allison Gray: Absolutely.

Dr. Ryan Gray: What else do you have to add for that one?

Dr. Allison Gray: So I would just reiterate a lot of what you said, or maybe in just my own words, I think it’s just so important for establishing rapport to- and also for making the patient feel like you’re a human being who cares about them, not just their doctor. That you really get to know them as a person. It will also- you’ll remember your patients better, you’ll really have a better bond with them if you really take the time to get to know who they are and their life in general, and get to know the fact that they have two kids at home and that’s why they’re not sleeping at night. Get to know the fact that they have a son who is troubled and drinks too much and they stay up late at night because they’re worried about him. I mean there are all these things that will not only help you be more informed and understand better why their health is the way it is, or why they are not compliant, but it will better your relationship and make it stronger and so that you really- and they’ll come to rely on you more. I can’t tell you- I mean the patients who I got to know better- you just- that relationship, the strength of that relationship just really makes a difference in terms of their care. And you can’t really replace that with anything.

Dr. Ryan Gray: Yeah. I agree. Alright the last one here, I think is simple and kind of a given, but it’s not always followed.

Dr. Allison Gray: It’s probably usually not followed, yeah.

Dr. Ryan Gray: Let’s just be honest.

Be Honest and Up Front

Dr. Allison Gray: Yeah. Well and this- so two things about this. In one of our earlier podcast episodes from last year, we talked with Cheri Blauwet and she’s a Paralympian, she’s a physiatrist, she’s a rockstar, she’s amazing.

Dr. Ryan Gray: Yeah, that was episode 66.

Dr. Allison Gray: Yeah, so we love her. One of the things she talked about in being a person living with a disability is that in her childhood whenever she saw physicians, it was always important to her that people just be honest with her and just level with her. And she said something which just stuck with me which I believe is so true too, which is that when you go to see a doctor you just want them to be down to earth. You don’t want them to give you any BS. Is this PG? I was going to say-

Dr. Ryan Gray: Yes, we do not have an explicit tag on our-

Dr. Allison Gray: Right, right, right. Okay. They don’t want BS, they want the patient- we all as patients want the true. We want our physicians to just tell us what’s going on. What is going on? Don’t beat around the bush, just be honest. So there’s that piece of it, and then there’s the part of the honesty just about yourself in terms of well what if you were short with the patient. What if you were rushing one day and you were short with them, or what if you were even rude or what if you were rushed; whatever it may be. It’s okay to pause and say- or maybe call them after the fact. Ideally pause and just say, “You know what, I’m sorry. This has been a really difficult day for me, or I didn’t sleep last night,” or whatever it may be. Or maybe tell them- maybe if you’re actually in an argument with a patient, maybe the patient starts shouting at you and you lose your cool and you- not shout back but you get upset. It’s okay to say, “Can we start over? I’m sorry, I got upset with you. I want to pause and I really want you to feel listened to, heard, respected, feel like in coming here that people care about what’s going on with you and we’re trying to make you better. Can we start over or can we pause? Can we just do a mulligan?” I think that- I’ve seen firsthand from my own personal experience that this can really make a big difference for a patient. You can do a 180 from a patient feeling like, ‘Well screw this, I’m out of here. I hate doctors, I’m never coming back.’ To, ‘Who, okay. This person is just leveling with me and-We’re people, right? We are people as physicians and we have bad days, too. And I think it can only make your relationship stronger with a patient if you’re honest. There’s nothing to be gained by just trying to be high and mighty and feel like, ‘Oh I don’t need to apologize,’ or some crazy attitude like that. You’re a person and it’s okay to just level with people.

Be Honest About Your Knowledge

Dr. Ryan Gray: Yeah, and I think following along those lines as well, being honest about your knowledge.

Dr. Allison Gray: Oh, definitely. Big one.

Dr. Ryan Gray: So being able to say, ‘I don’t know,’ if a patient asks you something. If a patient asks you about a lab that you were supposed do, being honest and saying, “Oh we forgot to order that but I’ll go put it in right now.” Or whatever it may be. Just be honest.

Dr. Allison Gray: Yeah, absolutely.

Dr. Ryan Gray: Not trying to hide anything.

Dr. Allison Gray: Yeah. I think they talk about how do you get sued- and the way that that happens is with negative rapport and how does negative rapport happen? It’s through bad communication, and if you’re being dishonest or you’re not- you’re trying to just be perfect all the time and not let people know when you have made a mistake or when you don’t know something, the results are not going to be in your favor. So it’s so important to be honest when you don’t know something, to use your resources, to tell a patient, “Look, you know what, I need to look that up or I’m not sure but I’ll get back to you on that.” Or, “Let me refer you to somebody who does know or who can help you with that.” And Ryan, I have a last one that we forgot to- or not forgot but that we did not write down here.

Dr. Ryan Gray: Okay.

Communicate With Your Team

Dr. Allison Gray: And that’s important for communication. So in terms of communication, and making communication better with patients, a crucial thing to do- and you can do this as a premed and as a med student and beyond, is to communicate with your team. Because in order to have good communication with a patient, you inevitably are working as part of a team. If you’re in an out-patient setting, if you’re certainly if you’re inpatient. And so, like for example if you’re taking care of a patient in the hospital, communicate with the patient’s nurse. There are a lot of hospitals now that use something called nursing rounds where there’s actually a time and place every day where physicians will round and meet with the nurses or the nurses will be part of regular rounds. Because nurses are running around taking care of patients and dispensing medication and if you as the physician don’t communicate with a patient’s nurse and the rest of the team and the case manager, it’s- everything is just going to go to hell in a handbasket. It’s terrible. And a lot of people talk about how a rushed physician- or maybe not even rushed, but a physician will go in the room, tell a patient a whole big thing, and then they’ll leave, and then what happens? The patient starts crying and goes to the nurse, “What am I supposed to do now? I’m totally confused, I don’t understand a thing they said.” If you haven’t explained to the nurse, or you haven’t gotten feedback from the nurse about how the patients is doing, they’re not going to be able to tell- to help the patient either. So it’s so important to be able to communicate effectively with the team that you’re working with to- then that itself will allow for good communication with the patient.

Dr. Ryan Gray: I agree.

Dr. Allison Gray: There you go, I added one. An extra.

Dr. Ryan Gray: There we go, bonus tip for the day.

Dr. Allison Gray: Bonus.

Dr. Ryan Gray: No charge.

Dr. Allison Gray: We don’t charge here.

Final Thoughts

Dr. Ryan Gray: Oh, that’s right. Well I hope you were able to take a lot from our discussion today. I think it’s a very important discussion. Like I said for your satisfaction, for the patient’s satisfaction, for their care and their outcomes, communication is probably the most important part of healthcare.

Dr. Allison Gray: I agree completely. It’s the key to any relationship. And you have a relationship with your patient.

Dr. Ryan Gray: Yeah. Speaking of relationships; if you love listening to us go to www.MedicalSchoolHQ.net/iTunes and leave us a rating and review if you haven’t yet. We’re up nearing 250 five star reviews which is amazing.

Dr. Allison Gray: Wow! That is incredible.

Dr. Ryan Gray: We got a few more this week. FatToSkinny said, ‘Great source.’ Rac- I’m assuming that’s short for Rachel Elizabeth says, ‘Thank you,’ she’s from Canada. SNJB2 says, ‘Great info.’ And JennyFromTheNYCBlock says-

Dr. Allison Gray: You almost said NYMC Block.

Dr. Ryan Gray: NYMC Block.

Dr. Allison Gray: That’s our medical school.

Dr. Ryan Gray: Says, ‘Fantastic.’ And then I want to take a second. We got an amazing email from a listener with the initials MM, I won’t say her name because she didn’t give us permission to talk about it. But it was just such a profound email and I just wanted to read one little snippet of it because I think- what she said is and has been our motivation for doing these shows. And she said, ‘Every week on the show you guys share invaluable information about the ups and downs of becoming a physician.’ Perfect, that’s what we try to do. But here’s what hit home, ‘However I am most appreciative of the sense of hope you have brought to me and my path towards becoming a physician. Since listening to the podcast I have returned to my premed coursework with much greater academic and personal success. I no longer worry about the cutthroat students who tell me to give up. I’ve found physician mentors who believe in my abilities of which I consider both of you to be even though we’ve never met.’ So that’s awesome. That has been my goal. I always said if I can take one student that reads the well-known forum out there- that three letter forum, reads that forum and reads what they think they need to do, or need to be as a premed student, and is discouraged and gives up on that journey. If they find this podcast and are reignited with the passion that this student is and has been by the podcast, then- and they go on to be a physician, then I’ve accomplished, we’ve accomplished our goal.

Dr. Allison Gray: Absolutely. That email was so amazing, and we are so glad to be able to provide hope and inspiration, whatever it may be- optimism, to you out there on the very difficult journey that you are on. The premed journey is so hard and the journey beyond is harder, and it’s a hard journey but it’s such an important journey, and so thank you for that email, and thank you so much for letting us know. It’s so rewarding to us to know that we’re making a difference for you, because that’s why we do this. We don’t do this to sit across from each other in our basement.

Dr. Ryan Gray: You don’t like sitting across from me in our basement?

Dr. Allison Gray: I like sitting across from you in our basement. Just kidding. But I just mean we really do this for you out there, and so thank you for letting us know that we make a difference to you.

Dr. Ryan Gray: Yeah. Alright. If you haven’t yet checked out www.PreMedLife.com, go check them out. It’s a magazine specifically for premed students. They offer bimonthly issues and have fantastic articles written about every aspect of the premed life. Hence www.PreMedLife.com. Go check them out, www.PreMedLife.com. If you have questions, feedback, or anything go to the show notes, www.MedicalSchoolHQ.net/111. Shoot me an email, Ryan@medicalschoolhq.net. Allison is Allison@medicalschoolhq.net. Or come find us anywhere else online; we’re everywhere, just come find us. Alright I hope you join us next time here at the Medical School Headquarters.

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