Communication Dos and Don’ts
The challenges of working in an under-resourced health care system with time constraints and competing priorities can make it more difficult to be mindful of basic courtesies.
“When a physician is running on empty, compassion fatigue is prevalent,” said Dr. Anil Chopra, a Toronto emergency physician and a CPSO medical advisor.
But he says too many of the complaints CPSO receives are the result of patients feeling disrespected during an interaction with their physician.
College complaints relate to the way physicians communicate with patients, their families and colleagues, both in written and verbal form. Cause for complaints would include perceived dishonesty, sarcasm, uncompassionate behaviour, condescension, yelling and rudeness.
“Most doctors are empathetic, but I think with time stressors and other ills within the system, we could end up being more terse than intended. Yes, we are working in an over-stressed system with many of us feeling the effects of burnout. We see people, however, at their most vulnerable and what they need most from us is empathy,” he said.
Worries about delays in their care might see some patients vent their anger with the system at the physician sitting in front of them. Physicians, he said, should avoid internalizing any expressions of anger, and instead focus on the patient’s concerns and fear. “This is not to say that physicians must endure bad behaviour from patients or families, but to try to take the time to understand what issues lie beneath, which can be supported and managed,” said Dr. Chopra.
The recently released Ontario Patient Ombudsman’s Annual Report marked an uptick in the number of complaints it received from patients about an inability to receive care in a timely way. “The pandemic continues to be an important factor in the complaints [it] received,” noting concerns about staffing, access to care and communication issues related to frayed nerves headed the list of reasons patients filed a complaint in 2022.
“It’s a hard time right now for everyone — patients and health care professionals,” said Dr. Chopra. “We just need to remember to be kind and empathetic with each other.”
Some Communications Dos and Don’ts
A failure to explain an aspect of care appropriately to the patient was one of the most frequent issues identified in Inquiries, Complaints and Reports Committee (ICRC) investigations. This could include failing to describe the reason for a particular assessment, or the reason for a particular treatment, or for failing to describe other treatment options.
To ensure consent for a treatment is informed, physicians must: provide information about the nature of the treatment, its expected benefits, its material risks and material side effects, alternative courses of action, and the likely consequences of not having the treatment.
“Discuss the rationale for your clinical decisions with patients and listen to their concerns. Talk about why a treatment is necessary — or not necessary — alternative options, any uncertainties about the treatment plan, and shared goals and expectations” said Dr. Chopra.
The more invasive or risky the assessment and management plan, the more explicit and detailed the communication must be, he added.
“The physician needs to create a safe space for intimate and invasive examinations to allow the patient the time to ask questions if they arise before the examination begins. Furthermore, the physician should watch for verbal and non-verbal cues by the patient to adjust the examination accordingly,” said Dr. Chopra.
Interrupting patients before they can express their concerns raises the potential for an incomplete understanding of your patient’s complaints and, ultimately, their dissatisfaction with the interaction.
Share within Circle of Care
Ensure those within the patient’s “circle of care” have access to relevant, accurate and up-to-date information about shared patients.
A shared understanding of patient goals, and patient’s conditions and medications between distinct providers supports patient safety and high-quality care.
Communicate Test Results
When in receipt of a clinically significant test result, physicians must always communicate the test result to their patient and must do so in a timely manner.
Read CPSO’s Managing Tests policy for more information.
Be Respectful of Patient Autonomy
Communication issues, said Dr. Chopra, can often arise from a clash of values — for example, a physician who appears to be unsympathetic to a patient’s refusal to stop smoking or to limit their alcohol consumption.
“I think physicians need to be mindful that they can speak to a patient in a way that is respectful and preserves the patient’s autonomy to make informed decisions without endorsing unhealthy behaviour,” he said.
“No matter what you think of someone’s choices in life, you can still have conversations about their choices, and why they may be inconsistent with what you think is in their best interests. This can always be done in a way that does not sound condescending and diminish the patient. The patient must believe that you are their ally,” said Dr. Chopra.
Patient privacy concerns go beyond medical record keeping. Conversations with patients in examining rooms, hallways and reception areas are at risk of being overheard by other patients. In some instances, patients have complained that they could hear their doctor speak about them — sometimes unflatteringly — to other health care professionals or their staff.
- Provide information clearly and simply. Try not to use jargon.
- Ask questions to confirm a patient’s understanding of the discussion.
- Be alert to non-verbal signs that the patient may not understand the information.
- Make eye contact.
- Demonstrate a collaborative approach to patient decision-making.
- Wait until the patient is finished speaking to respond.
- Summarize what you think the patient has told you and ask the patient whether it is correct.