Better Communication Improves Not Only Patient Experience, But Also Physician Experience
Dr. Adrienne Boissy, a neurologist at the Cleveland Clinic, was recently handed a unique assignment: improving the communication skills among her fellow health care workers. Her training was successful.
Dr. Boissy, and Dr. Rich Frankel, a professor at the IU School of Medicine, explain the importance of working toward higher quality patience experiences, and how this affects clinicians.
On the pressures of health care
Boissy: "Clinicians are facing some of the greatest pressures in medicine that they’ve ever faced. Less time to see patients and yet now held accountable for how patients interpret those experiences."
On the necessity of good doctor-patient relationships
Boissy: "I think many people value clinical excellence as a part of their health care. In fact you can’t have excellent health care without it. The good news is that relates to our definition around patient experience, which is you cannot deliver an exceptional patient experience without being able to deliver high-quality care, high-value care and safe care."
Frankel: "There’s a great deal of evidence these days that patients not only want good outcomes, but they want physicians who genuinely care about them as human beings. They want to be known as a person who has a disease not just the disease itself."
On how to help doctors improve
Boissy: "My goal isn’t to teach people how to care. My goal walking in is not to teach them how to do it better but to facilitate a dialogue around how difficult it is to be a caregiver in today’s health care system. What are the challenges you’re facing? When you have gotten stuck communicating with the patients, where have you gotten stuck and how can we brainstorm how we can get you out of there? I think that’s the sweet spot for many caregivers, is I don’t necessarily always know what I don’t know, but I sure know when I get stuck and I sure know when it doesn’t feel good. So for me, getting them to be in a space where they can reflect on that and maybe raise some self-awareness that they may not be doing it as effectively as they think and also creating a space where my own caring for them as a facilitator of this process can engender caring in them for the patients we serve."
The emotional impact on doctors
Boissy: "I don’t think you can be doing this work without it having an impact on you. And I hear that from just about every caregiver or physician I come across. I think if it isn’t having an impact on you then that would be something else to talk about. I think they call it bad news because it feels bad for patients and also it feels bad for the person who’s delivering it. And I certainly hear that from people that we’re working with."
On getting "stuck"
Frankel: "I was recalling being at the bedside early in the AIDS epidemic of an AIDS patient and I had never interviewed an AIDS patient before and there were six other people in the room observing me and I just drew a blank. It was embarrassing; it was humiliating. Fortunately I was in a small group where there was an opportunity to practice the skill so we went back, we reviewed what had happened, and reviewed alternate strategies. I practiced those strategies, then went back into the room and did a successful interview. It was really an emotional rollercoaster just going from feeling terrible about a skill that I didn’t really have or hadn’t developed very well and then having the opportunity to practice it and get it right."
On increasing training in medical school and beyond
Boissy: "I’m not an educator by background, I’m a normal neurologist. My view of it is that these days, we spend an incredible amount of time and make an enormous investment in communication skills training and humanism. When people are students of medicine, they have the least experience and are working very hard to hone their content knowledge. Then throughout residency there are less opportunities to implement that training in a reproducible way throughout their residency and the pressures become very, very different than what they were as a med student. I worry sometimes we make it about tasks as opposed to the purpose of medicine and caring for people. Then we graduate people to become staff physicians and there’s hardly any reinforcement or programs that hone in on faculty development. So here we’ve created a situation where the staff physician is held accountable for things like patient experience and yet we are just beginning to understand that we need to provide our staff physicians with the tools that we were using as far back as medical school."
- For more information about the communication curriculum developed by Dr. Boissy, visit the Cleveland Clinic's website.
- On Nov. 11, 2013, Dr. Boissy spoke with Cleveland Clinic staff about physician communication. Here's the video: https://www.youtube.com/watch?v=RoFEfulh4xo