Enhancing Physician-Patient Communication
Hematology ASH Education Program
Patients' descriptions about their illness experiences are replete with stories of conversations gone wrongand right-and patients repeatedly reflect on the importance of the way these conversations are held-the setting, the use of words, the nature of the physician's emotional connection with the patient-as being critical to and highly influential on their subsequent adaptation to illness and treatment. Obviously, when the news is good, or the outcomes optimistic, communication specifics may
... on specifics may fade more into the background. However, in "high stakes" conversations, such as those that take place around disclosure of bad news, attention to these nuances of communication may help optimize patient adjustment and the partnership that is essential between physician and patient (and family). Patients report a variety of emotional reactions to hearing bad news. In a study of patients diagnosed with cancer, the most frequent responses were shock (54%), fright (46%), acceptance (40%), sadness (24%), and "not worried" (15%). 2 Patient confusion can be an important contributor to the distress commonly seen following a bad news discussion, and the biggest source of patient misunderstanding is technical language. For example, in a study of 100 women who were diagnosed with breast cancer, there was substantial misunderstanding of prognostic and survival information, with 73% not understanding the term "median" survival when it was used by their physician. 3 Furthermore, there was no agreement on the numerical equivalent of a "good" chance of survival. Physician-patient communication encompasses the verbal and nonverbal interactions that form the basis for the doctor-patient relationship. A growing body of research and guidelines development acknowledges that physicians do not have to be born with excellent communication skills, but rather can learn them as they practice the other aspects of medicine. Improvement in physicianpatient communication can result in better patient care and help patients adapt to illness and treatment. In addition, knowledge of communication strategies may decrease stress on physicians because delivering bad news, dealing with patients' emotions, and sharing decision making, particularly around issues of informed consent or when medical information is extremely complex, have been recognized by physicians as communication challenges. This paper will provide an overview of research aimed at improving patient outcome through better physician-patient communication and discuss guidelines and practical suggestions immediately applicable to clinical practice.