Do’s and don’ts for effective patient-physician communication

With misinformation rampant on social media and elsewhere, physicians are well-versed in the challenges of successfully communicating accurate medical information to their patients. The question they may be left with, however, is how best to overcome those challenges and accomplish that herculean task.

Seeking to provide answers on that front, the authors of a JAMA Insights column broke down the elements of effective communication between physicians and patients and offered tips on how to create it.

The stakes are high.

Communication “failures can be medically significant,” the article says, “affecting adherence to prevention, screening and treatment; undermining the patient-clinician relationship; increasing anxiety and confusion; exacerbating health disparities, and accepting misleading, incomplete or false medical information from ill-informed sources.”

The column, “Delivering Effective Messages in the Patient-Clinician Encounter,” was written by Joseph Cappella, PhD, of the University of Pennsylvania Annenberg School of Communication, and Richard Street Jr., PhD, of Texas A&M University and Baylor College of Medicine.

Physicians can use relationship-building techniques in their everyday practice to better relay crucial medical information and to encourage their patients’ acceptance of that information, they say.

“Effective communication in the clinician-patient context is not just window dressing. It actually is a medical outcome, in many respects, when it goes awry,” Cappella said in an episode of the “JAMA Author Interviews” podcast. “We want to make sure that the communication process … is as effective as we can be and as efficient as we can be.”

With that in mind, the JAMA Insights essay lays out several steps for clear, informative andpersuasive communication that physicians can use with patients. An overriding goal is to foster cooperation and trust with patients, the authors wrote, detailing communications strategies to uncover patient information, provide information to patients, promote values, and check understanding.

In a table, the authors provided examples of do’s and don’ts for effective communication with patients and how they align with different goals and strategies, as outlined below.

• Do say: “I’m running late. Sorry. Couldn’t be helped, but now my time is all yours.”
• Don’t say: “I’m running late. Sorry. What a day I’ve had! I’ve been buried.”

• Do say: “Changing behavior is tough. Let’s talk about some ways to move forward.” Or: “Tell me what has worked for you.”
• Don’t say: “You need to take control and make the change. It’s your choice to do or not.”

• Do say: “What concerns bring you in today?”
• Don’t say: “Let me check on what I asked you to do the last time.”

• Do say: “Let’s explore that last issue in more detail. What do you think is going on?”
• Don’t: Assume what the patient is experiencing; dismiss or complete the patient’s comment; interrupt.

• Do say: “So you’re concerned about the … tell me more about that.”
• Don’t say: “No, that’s not right. There is no evidence for that.”

• Do say: “The best medical science today usually requires …” Or: “There are pros and cons. Let’s explore the benefits and harms honestly.”
• Don’t say: “The test numbers don’t lie. They can only mean one thing.”

• Do say: “The report is full of doctor talk. Let me tell you what it means in plain language.”
• Don’t say: “Once the antigen-specific antibodies are produced, they work with the rest of the immune system to destroy the pathogen.”

• Do say: “Your loved ones need you to be the healthiest you that you can be …” Or: “You take care of your family, and part of taking care of them is taking care of you”
• Don’t say: “You need to get your priorities straight.” Or: “No, what should be important to you is …” 

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• Do: “Prebunk” the information, not the people: “Some false rumors have circulated locally about … Here are the facts.” Or: “Here’s what we know.”
• Don’t say: “There are a lot of ignorant and dishonest people promoting the idea that …”

• Do say: “When someone close to me had to deal with a similar condition …” Or: “I had a patient who …”
• Don’t say: “If you want to be sure, I can send you to the medical journals for more.”

• Do say: “So, would this approach work for you?” Or: “This can be confusing. I want to be sure that I explained it clearly. Please tell me what your understanding is.” Or: “And our next steps will be …”
• Don’t say: “So, that should be clear to you now,” or assume patient understands when they don’t ask questions.

In short, the tips are about creating an environment in which patients feel cared for and understood, which leads to better medical outcomes and more trust in medical professionals. Creating that relationship can take time, though.

“Effective communication takes deliberation and practice,” the article says.

The most recent piece is part of a series that JAMA introduced earlier this year called “Communicating Medicine,” which is intended to help physicians relay the crucial information their patients need to become and stay healthy.

Physicians “have an important role as trusted sources of medical information,” says an editorial introducing the series that was written by JAMA Associate Editor Anne R. Cappola, MD, ScM, and JAMA Editor-in-Chief Kirsten Bibbins-Domingo, PhD, MD.

Helping doctors “deliver accurate information more effectively can lead to better-informed patients,” they wrote.

Learn more with the AMA about how “medspeak” can shut down effective communication with patients.