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Effective Communication
Contributed by Mike Rabow, MD, FAAHM
Director, Symptom Management Service
Medical Director of Palliative Care, Helen Diller Family Comprehensive Cancer Center
Director, The MERI Center for Education in Palliative Care at UCSF/Mount Zion
Associate Chief of Education & Mentoring, Division of Palliative Medicine
Respecting our patients and their loved ones is a necessary element of effective communication and central to a therapeutic relationship. Showing respect means valuing who the individual is-- their qualities, their worth, their personhood. Showing respect means assuring people that they matter to us.
Elements of communication that demonstrate respect for the patient
Here are 6 categories of skills that communicate respect.
(1) Preparing to Communicate
Taking the time before the clinical visit to prepare for the visit is key. Knowing the patient’s history, the clinical situation, the consultation question, the urgency, or the prior clinical/insurance/administrative challenges all can help communicate to a patient that they matter to you
(2) Listening
The first and foremost communication skill for showing respect is listening well--as an attitude and/or a technique. Clinicians can use “conversation continuers” (such as “uh-hah” or “I see”) and non-verbal communication (such as a nod or eye-contact [on zoom or in-person]). Of course, active listening means not interrupting the patient.
(3) Silence
demonstrates that you are not trying to rush the patient and are allowing them the space and time to consider serious issues, including feeling difficult emotions.
(4) Responding
Authentic curiosity and a warm invitation to say more are instrumental in effective communication across difference.
(5) Our Notes
As was said in a recent paper on quoting patients in clinical notes, "Quotes may be beneficial when it is important for the reader to know that the patient said exactly those words, but clinicians should never use quotations to ridicule a patient, express frustration or disapproval" or insinuate that the patient is untruthful (Beach. Ann Intern Med. 2021).
(6) Kindergarten Communication Skills
Be polite and be kind. Say please and thank you. Look people in the eye when you are listening and talking. Extra credit if you can maintain eye contract during the intimacy of silence.
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