How to handle difficult patient conversations

How to handle difficult patient conversations

Doug Brunk

Los ANGELES — If you’re having a difficult conversation with a patient and someone is interfering, don’t hesitate to remove that person from the room, even if that “someone” is a small child, Dr. Martha Bernadett advised at the annual meeting of the California Academy of Family Physicians.

“It’s difficult to remove small children because your offices are not set up as day care centers,” said Dr. Bernadett, a family physician and executive vice president and CEO of Molina Healthcare of California. “But sometimes you just have to ask the medical assistant to stand out in the hallway for a few minutes with the child. You want your patients to have the level of communication they need on a sensitive topic.”

The reverse also holds true, she said. Ask patients if they want other key people in the room with them during a difficult conversation. If so, invite them to bring that person in the office for another conversation.

Dr. Bernadett offered several other tips on successful physician-patient communication. For example, when you discuss a medically simple yet sensitive topic with a patient, such as pregnancy, sexually transmitted disease, or sexual dysfunction, make sure you have a prepared response. Preparation will help you and the patient feel more at ease.

“Know what presses your buttons, and prepare a standard approach that you’ve thought about before that patient walks into the room,” she advised. “Know your biases and be honest with yourself about your biases. If there is a bias you have, you may want to state it.”

One of the ways to address that is to practice beforehand, perhaps through role-play with your colleagues. When you discuss a medically complex subject that is not sensitive, such as abnormal lab results or uncertain diagnoses that may require a long work-up, clarify the expectations of the communication with the patient.

“When you clarify it upfront, and you both agree on what it is you’re trying to talk about and achieve, and that puts down one communication barrier right away,” she said.

Make sure to tell patients what you know as well as what you don’t know about the matter of concern. For example, you can tell your patients that you don’t know everything about a particular work-up without appearing as though you’re uninformed. “You may not be up-to-date each day on what the current therapy for AIDS is, or what the status of severe acute respiratory syndrome is, but use additional resources as appropriate and know your next steps,” she said.

When you discuss a medically complex and sensitive subject like AIDS or breast cancer, allow for a certain amount of shock time. “If you tell a woman that she has a lump in her breast and it might be cancer, she is not going to listen to the next three or four sentences you say,” Dr. Bernadett noted. “In that case, you might want the patient to come back a little bit later, or write something down, or press forward and ask them to repeat what you just said.”

Chaperones and interpreters can affect your ability to deliver effective communication during such difficult times. Dr. Bernadett said that most physicians are not prepared or trained to work with interpreters and urged them to seek out CME and monographs on the subject. “Working with interpreters is a reality of our life, and it’s going to increase, because we can’t speak all languages at the same time,” she said.

Perhaps the most important thing of all, she said, is to allow patients to have hope, no matter what their prognosis. “Don’t take that hope away,” she said. “Patients look to their doctor for truth and for comfort, and we have to live with that. Don’t forget to ask questions, such as ‘What is your worst fear?’ and ‘How I can I help?'”

She also shared these tips:

* Be empathetic. “What you’re talking about is patient satisfaction,” she said. “If people are satisfied, they’re more likely to take your advice and behave the way you’re advising them to.”

* Don’t judge. Try to understand the patient and his or her culture and “how to talk about things in a culturally appropriate way.”

* Speak simply. Try to find more consumer-friendly terms for words like pharyngitis, otitis media, and URI.

COPYRIGHT 2003 International Medical News Group

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