Earlier this month I spoke at DDW, the national gastroenterology meetings during the AGA Postgraduate Course on the topic: Maximizing the Patient-Provider Relationship Using Effective Communication Skills for IBD and/or IBS. I told a room full of clinicians that “it is not what you do as much as how you do it that makes the difference” (i.e., affects the clinical outcome).
In other words, it is not the choice of any specific treatment but how you communicate the process of care relating to that treatment that leads to patient satisfaction with your care.
I wanted to share again here some of the highlights of the session, where I was joined by my colleague, health psychologist Laurie Keefer, PhD, AGAF, associate professor of gastroenterology and psychiatry at the Icahn School of Medicine at Mount Sinai, New York, NY.
One of the main points stressed during the session is something I have written and spoken about for many years: patients with functional IBS, IBD and other disorders expect four things from their clinician in order to be satisfied with the care:
- They want an adequate level of technical competence.
- They want the provider to understand and connect in some manner with their psychosocial world.
- They want the provider to be humane.
- And they want to hear the biomedical information, but not so much they can’t comprehend it.
If patients are satisfied with their physician, the physician is usually satisfied with the patient. And we know that physicians who are not satisfied with their patients are at higher risk for burnout and for malpractice suits. Malpractice is less about what you did than how you communicated with the patient.
Improving patient communication begins with active listening. Active listening means that the clinician formulates the next question based on what they heard from the patient, rather than from an a priori set of questions. By listening to what they say and how they say the provider can better understand the nature of the illness and how best to treat it.
I suggest the following steps to facilitate this process:
- Sit back and listen, you can learn a lot more. Then you can use that information to formulate more targeted questions.
- Identify the patient’s agenda. Patients may schedule visits because of symptoms, but there are always deeper concerns influencing these symptoms that they may be reluctant to bring up.
- Acknowledge and validate patients’ feelings about their symptoms and their disease. Don’t rely only on endoscopic or laboratory data. You have to understand the patient’s personal perspective of ill health and integrate with this the medical data.
Patients need help adjusting to the chronicity of their disease and the roller coaster of flare, remission and flare.
Understanding and addressing the patient’s concerns is key, according to Dr. Keefer, who said that patients need help adjusting to the chronicity of their disease and the roller coaster of flare, remission and flare.
Key take-aways that she made during our talk include making sure clinicians understand the following about their IBD patients in particular:
- Patients must deal with social stigma and potential financial implications of their disease or condition.
- Treatment adherence also can be an issue, particularly during periods of remission.
- Patients may be afraid of the drug delivery system, whether it is injection, infusion or even pill swallowing.
- Patients with severe or long-term disease can be appropriately concerned about being accommodated as needed or becoming disabled.
- Most patients have extra-intestinal and treatment-related concerns around body image and weight gain from steroids. There also may be worries about ostomy, fatigue, disability and a variety of other issues.
“There is a lot of anxiety that goes along with these conditions,” Dr. Keefer said. “Knowing that the provider is on that journey with you can make a big difference in how well patients manage their disease.”
For further information on educational programs to teach patient centered care visit www.drossmancare.com
For information about Dr. Drossman’s patient practice visit www.drossmangastroenterology.com