Establishing the Physician-Patient Relationship is the first of a four-part series that provides more information and insight about ASA’s Enhancing Patient Communications Program.
It is easy to forget how stressful the overall surgical experience can be. Even though it may be unfamiliar for the patient, it is just another day at the office for us. Document the history and physical, get the consent, start the case – the pace can be unrelenting. Efficiently providing even the most essential aspects of patients’ preoperative care can be challenging – and now we have to take the time to schmooze?
Yes. Even the anesthesiologist who feels indifferent to patient appreciation rarely feels indifferent to the adjusted payments that accompany below-average patient satisfaction scores. Satisfaction is driven by perception. How well you interact with your patients will have an outsized impact on this perception, because the patient is unconscious for everything else. More importantly, if we want allies to recognize the anesthesiologist’s leadership role on the anesthesia care team, they must understand the value we bring to patient care.
It can be difficult to value what you do not understand. For patients, it is relatively easy to value the physician who is going to operate on their chest and fix their heart. But what about the physician who is going to put them “to sleep”? Many patients do not know we are physicians. This lack of understanding increasingly is proving to be a liability – an unnecessary one. Communication with patients is a skill that usually takes some focused practice, but once you have acquired it, your patients will have a clear understanding of who you are and what you bring to their care.
The Enhancing Patient Communications Program toolkit was developed to provide you with resources to enhance your patient experience, beginning with effective communications in all patient interactions. While this is important for all health care providers, it’s essential for anesthesiologists, who have limited time to build relationships with patients. The toolkit leads with an extensive section on Establishing the Physician-Patient Relationship because, let’s face it, it all begins there. First impressions are important, and your first meeting with a patient plays a huge role in how they perceive you and their anesthesia experience.
This section of the toolkit provides a wealth of specific recommendations and examples for quickly establishing an individualized and meaningful relationship with each patient, based on significant research, as well as the experiences of a number of us who participated in an ASA Committee on Communications subgroup to develop it. In the following, I’d like to share more about the insights and suggestions in the Establishing the Physician-Patient Relationship section of the toolkit.
You may be doing some or even many of these things already, but you likely aren’t doing all of them. Those of us in the subgroup have learned new techniques and approaches from the research, and each other, and we hope you do, too.
Coming prepared to the first meeting with the patient goes a long way toward establishing rapport. Reviewing the patient’s chart in advance gives you the opportunity to ask insightful questions and let the patient know you are knowledgeable about their situation. I sometimes text the surgeon the night before, especially if it’s a surgery that isn’t done very often, asking if there is anything special that I need to know, and if so, I can communicate that to the patient. If it’s really important for the patient to take a specific medication, I will call them the day before to remind them. Showing the patient you are aware of their health really helps build that connection and your value.
Introduce yourself and establish roles
Introducing yourself as a physician and leader of the anesthesia care team is vital. Many patients don’t realize that anesthesiologists are physicians, and explaining you are the doctor in charge of their anesthesia – just as the surgeon is the doctor in charge of their surgery – helps them understand your important role. I also make a point of introducing the rest of the team, including clarifying the role of the nurse anesthetist. I’ll say, “You will be cared for by this excellent nurse anesthetist who will make sure you are doing OK during the surgery and will call me if they have any issues.” Establish your expertise and explain what you are about to do and that you will be in control. Let them know your number-one priority is to keep them safe and comfortable.
Research shows patients want individualized attention, so establishing a connection is important. It comes down to being curious about your patient. Really listen to them. Find out why they’re nervous and what most concerns them. Acknowledge that having a procedure can be scary, while reassuring them that their safety is your top priority. Talk about relevant aspects of their personal or medical history. If they’re wearing a team cap or shirt, ask about their love of that team. Even finding moments of levity, when appropriate and based on the patient’s personality, can help ease anxiety.
Connecting with the patient’s loved ones can help everyone feel comfortable before the procedure and let them know you are engaged on a personal level. It’s also important to read the room and adapt your communications style depending on the patient. Some want lots of detail about their anesthesia and some want very little information. Ask them what they prefer, and when you do, provide the explanation. With practice, you will find rushing is not necessary.
Developing a personal rapport and conveying empathy go hand in hand. Research shows physician satisfaction scores often are tied to the patient’s perception of their physician’s empathy. Expressing empathy means ensuring the patient understands they’ve been heard. The first step in expressing empathy is to show you are actively listening to patients’ goals and concerns. Some ways you can do this are by looking the patient directly in the eyes and not interrupting when they are speaking.
One approach is to use cognitive empathy, which involves repeating back to the patient what they just told you using your own words. It takes practice, but can be very effective.
Use nonverbal communication
It’s important to not only use the right words when talking to patients, but to employ effective nonverbal communication. Be attentive, and sit down so you are eye level with the patient. Use body language such as smiling and leaning forward to demonstrate your openness. Don’t bury your head in the computer – be polite. If you are doing something that takes your attention away from the patient, excuse yourself while you are doing it.
Switching from medical terminology to language that is clear, concise, and understandable for patients will help them better understand what you are doing. For example, say “place a breathing tube” instead of “intubate” and “a device to help you breathe” instead of “ventilator.” Don’t speak down to them – rather speak directly to them. Pause to confirm they understand and clarify any unfamiliar language.