Fine-Tune Patient Communication in Gastroenterology: The Role of EHR, Value of Face-to-Face Interaction & More
Ask a Gastroenterologist is a weekly series of questions posed to GI physicians around the country on business and clinical issues affecting the field of gastroenterology. We invite all gastroenterologists to submit responses. Next week's question: How can gastroenterologists keep up with quality reporting requirements in the field?
Aaron Benson, MD, Northwest Community Healthcare, Arlington Heights, Ill.: I think the key to optimizing communication is to realize that there is not a "one size fits all" approach. The means and manner with which any physician (not just gastroenterologists) communicates with any given patient might be influenced by the patient's age, gender, ethnicity, language skills and education level. These factors must be taken into consideration, not just during the time in which one actually sees and speaks to the patient face-to-face in the clinic or hospital setting, but also in which method is chosen to communicate follow-up concerns, be it by digital means (i.e. an online patient portal) or by more traditional means, such as phone calls and snail mail.
It also will clearly be influenced by what one is trying to communicate. For example, you might routinely have a medical assistant call a patient, and perhaps even leave a voice message, with a normal lab result. By contrast, a sensitive biopsy result should be handled during a real time conversation between the physician and patient.
In short, the best way maintain a high level of communication with our patients is to always try to do our best to individually tailor the message. Know your subject matter and know your audience!
David D. Clarke, MD, Oregon Health & Science University, Portland: At the start of the interview, wait for the patient to finish expressing all their concerns before interrupting with questions to narrow the differential diagnosis. It is not unusual for the patient to reveal important clues later in their opening statement, but these may never be heard if they are not given time to finish their thoughts. Rarely do patients speak for more than two to three minutes at the outset.
For patients thought to be suffering from a functional condition or medically unexplained symptoms, inquiry about sources of psychosocial stress often uncovers problems amenable to therapeutic intervention. These include current life stresses such as domestic violence; poor self-care skills; past history of an abusive, dysfunctional or stressful childhood and less than obvious cases of depression, anxiety or post-traumatic stress.
Ann Marie Stephenson, DO, Capital Digestive Care, Rockville, Md.: Listen. As a physician there are moments we feel pressed for time and as a result, tend to interrupt patients or inadvertently "out talk" them. If we allow the patient time to articulate their health complaints and concerns first, we can listen and think about additional questions we need to ask the patient as well as begin to formulate management and treatment options. This also makes a patient feel valued.
Engage. We can encourage patients to become active in their health care. This can be accomplished by inviting patients to openly ask us questions. In turn, we should also ask our patients to commit their efforts to their health care treatment.
Respect. How we choose to speak to our patients can strengthen communication or weaken it. Not having a medical degree, does not mean someone is uneducated or doesn't have common sense. The sign of a seasoned physician is the ability to explain a very complex problem in the simplest terms. Physicians have the power of words to soothe, comfort, counsel, encourage and praise. But sometimes our delivery can be dismissive and abrupt, and this can be perceived as arrogant and uncaring when it genuinely may not be intentional.
Patrick Takahashi, MD, CMIO and Chief of Gastroenterology Section of St. Vincent Medical Center, Los Angeles: Gastroenterologists can communicate with their patients in a multitude of ways. I have found that supplying written literature about procedures, diagnoses and the like seem to give patients a wealth of information from a secure source. It is a very consistent means of disseminating information. The internet is becoming a widespread means of spreading information as well, as I refer many of my patients to tried and tested sites which I feel comfortable with. In this manner, my patients are able to obtain reliable and detailed information regarding their conditions in a very organized fashion.
In the future, with electronic health records, patient portal access will be a means in which patients will be obtain information regarding their diagnostic tests, problem lists, medications and the like, and will serve as a bi-directional interface for both the physician and their office staff. Of course, in many instances there is no substitute for the telephone, and this is still our most powerful means of communication other than a face-to-face encounter. In any event, it behooves the gastroenterologist to be proactive about patient communication, especially considering that it will be a standard that we will be held accountable to.
More Articles on Gastroenterology:
The Growing Role of Biologics in Gastroenterology
Boosting GI Patient Volume: Keeping Up With Technology, Improving Patient Experience & More
AGA Research Foundation Names 2-14 Research Scholars
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