Patient Care

'Everything We Say and Do': Soliciting Goals from Our Patients and Their Families


 

Editor’s note: “Everything We Say and Do” is an informational series developed by SHM’s Patient Experience Committee to provide readers with thoughtful and actionable communication tactics that have great potential to positively impact patients’ experience of care. Each article will focus on how the contributor applies one ormore of the “key communication” tactics in practice to maintain provider accountability for “Everything we say and do that affects our patients’ thoughts, feelings and well-being.”

Read more from the “Everything We Say and Do” series.

What I Say and Do

Solicit a patient’s agenda and use active listening.

Why I Do It

The literature shows that, in most cases, doctors interrupt within 18 to 23 seconds and that when we interrupt, patients often never get back to what they were saying, the course of their story changes, and our diagnostic accuracy decreases. I also do it because I learn things that I wouldn’t otherwise know, and my patients feel heard and treated with respect. Listening has a healing effect, and in medicine, it can be equally if not more therapeutic than the medicines and clinical care we provide. I find that it helps me to be a more effective doctor, one who is helping my patient in the way that is most meaningful and helpful to them. It is very easy to navigate an encounter from the physician point of view and to make assumptions about what people want and need from me, but in reality, what is most important to me is not always what is most important to them.

Allowing patients to tell me what is important shows them respect and also sets me up for success as I am more likely to know and meet their needs. Doing this up front saves time by preventing the “doorknob” questions on the way out.  The human connection that follows keeps me connected to my purpose as a doctor. People often worry that listening will take too much time, but we know from the literature that most patients will talk for no more than 90 seconds. It’s really a very short amount of time for a gold mine of information.

How I Do It

Before I jump into my agenda, I make sure to know what is on the patient’s and family’s mind. What is most important to them to address? Once we have agreed on what we will be discussing or doing with our time in a way that includes both what I and the patient/family find important, I start by asking the patient to tell me everything about the first item at hand. I do not interrupt by asking questions, making comments, or “fixing.” I approach them with authentic curiosity, encouraging more without directing what they say.

I start with, “I’m here to talk to you about _____, but first, can you tell me what you’d like to make sure we talk about today?” Or, “Tell me a list of things that you’d like to make sure we talk about today.”

I follow that with, “What else?” until there is nothing else. Once we have negotiated what we will discuss, I say, “Tell me all about _______.” I do not interrupt or think about my response while I am listening. My only response is to use nonverbal continuers (“Uh huh,” “mmmm”), reflections (“That sounds really hard”), verbal continuers (“Tell me more”), empathic statements (“I can see why you would feel that way”), and body language that shows I am with them (sitting at eye level, facing them, looking at them rather than at my phone, pager or a computer screen.)

All of this happens before I jump into any of my own focused or clarifying questions.

Dr. Sliwka is medical director of patient and provider experience, medical director of the Goldman Medical Service, and associate clinical professor of medicine in the Division of Hospital Medicine at the UCSF Medical Center in San Francisco.

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