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Doctors at Hospitals Learn How to Communicate Effectively With Patients

Posted on: Friday, 21 April 2006, 15:00 CDT

By Michael Amsel, Asbury Park Press, N.J.

Apr. 20--When Dr. Edward Niewiadomski arrived at Southern Ocean County Hospital in May 2005, one of the first things he examined was a customer satisfaction poll. He was surprised to see that the physician satisfaction results lagged behind many other categories in the hospital.

"While the rest of the groups were scoring 90s, doctors were below that," said Niewiadomski, the hospital's senior vice president of medical affairs. "It wasn't a significant difference, but it was noteworthy."

Physician communication skills have become a major focus at hospitals and medical schools around the country, according to a recent Mayo Clinic study. Interviews with 192 Mayo Clinic patients in Minnesota, Arizona and Florida identified seven different behavior traits that respondents said describe an ideal physician: confident, empathetic, humane, personal, forthright, respectful and thorough.

The study suggested that training new and practicing physicians about interpersonal skills could have far-reaching benefits for patients.

"The field of medicine is going through a transition," said Dr. James Lee of the Mayo Clinic in Rochester, Minn. "Five, ten years ago there was very little attention devoted to communication and improving skills for residents and medical students. They basically learned on the job and watched residents, without any curriculum. What those students learned was to be efficient, quick, cold and clinical."

Not what people want, studies have shown.

So now, more medical schools and hospitals have developed specific programs aimed at helping young physicians improve their skills in dealing with patients.

Dr. Alan Cabasso, who oversees the pediatric residency program at Jersey Shore University Medical Center, Neptune, said his colleagues are constantly exchanging ideas as they search for effective ways to communicate.

"It's a challenge to try and devise effective strategies to make young physicians good communicators," said Cabasso, vice chairman for education. "The quality of personal care is just as important as the quality of the medical care. We stress this to our residents repeatedly. It's all about effective communication."

Cabasso said hospitals have become more conscious of this with the increased use of patient satisfaction surveys. Once-reticent patients are now vocal consumers.

"I talk with a lot of people in my position and the issues often are not whether the patients got better or not, but how they were treated," Cabasso said. "Did the doctor take time? Was he patient? Did he communicate well? These are the things they talk about."

Niewiadomski said physicians are working longer days and seeing more patients, making their job more demanding.

"It takes a real talent to provide high-quality medical care and meet the softer side of medicine of being informative and courteous," Niewiadomski said.

Dr. Aimee Goodman is in her third year of a pediatric residency program at Jersey Shore University Medical Center. She said the best way for a resident to learn how to be a good physician is by emulating veteran doctors.

"As training, we go into the rooms by ourselves and do a history and a physical on the patient," Goodman explained. "I discuss the case with a senior physician, then we both go back in together. I watch the senior physician interact and listen to how he deals with the patient. Then, we discuss things I can improve on, which I find very helpful."

Goodman said the most difficult task for a physician is delivering bad news to a patient. She has had to tell the mother of a newborn that the child would not survive. In another instance, she had to inform a woman whose son was hit by an automobile that he was not going to make it.

"You can't learn to do that by reading a book," Goodman said.

"Let's face it," said Lee of the Mayo Clinic. "Breaking bad news to people is a human experience that is difficult for anyone."

At Jersey Shore University Medical Center, delivering bad news is a team affair. A member of the clergy and a social worker accompany doctors when a family member has to be notified.

"It is scary, but doing it as a team makes it easier," Goodman said. "It is just too much for one doctor. One person may have a weakness, so someone in the team may be able to pick up the slack. It is important to remember to deliver news slowly, so you don't overwhelm a family. You do it in pieces. You say, "Here are the things you need to consider." You try to be as human, as compassionate as possible."

To address his concern at Southern Ocean County Hospital, Niewiadomski started a patient satisfaction initiative in July 2005.

After patients are discharged and return home, they are asked to fill out the survey, which focuses on five aspects of doctor care: time spent, concern for worries, friendliness and courtesy, skills, and how well the physician kept them informed.

The hospital staff compiles the results and identifies opportunities for improvement. Then the results of the survey are sent to the individual physicians -- along with a tip of the month.

"The physicians loved it when they got the results. It's something new here," said Niewiadomski. "They said, "How can we fix something if we don't know the problem?' Now, they saw what the patients thought about them and are able to adjust."

Niewiadomski has noticed a heightened awareness among physicians and a flurry of higher scores. The first quarter of 2006 produced the biggest improvement since the initiative started.

"Now, you see them carrying the results around in their back pockets," Niewiadomski said. "It's clear they are proud of them."

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Copyright (c) 2006, Asbury Park Press, N.J.

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Source: Asbury Park Press

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