Clinical Expertise Isn’t Enough: Why Healthcare Professionals Need Cross-Training in Communication
If you are diagnosed with hypertension, does this mean that what you really need is to relax more?
Healthcare professionals often use the terms “blood pressure” and “hypertension” interchangeably. Unfortunately, according to recent research, people often interpret the terms very differently. A patient who hears that he or she has hypertension hears “tension,” and may interpret that to mean that they have too much (ie, “hyper”) tension and stress.
Hypertension doesn’t impose obvious symptoms that patients perceive. Many people don’t believe that anything is medically wrong with them because they don’t feel pain or sick; in fact, they feel fine, “normal.” Therefore, when some patients hear that they have hypertension, instead of adhering to their doctor’s prescription to take medication, lose weight, and get more exercise, they may forgo medications and lifestyle changes in favor of doing something that they think will decrease their tension and stress, such as relaxing more.
Doing things that reduce stress and tension are great, but they don’t lower dangerous blood pressure levels or cure hypertension.
What the Communication Gap Looks Like
Barbara G. Bokhour of the Boston University School of Public Health, sees the hypertension/blood pressure snafu as part of a larger failure of healthcare professionals to communicate effectively with patients. She states, “Oftentimes providers give information in a very rapid format, using biomedical language….Hypertension is one of many, many examples where providers have an understanding of a word and patients do not, and if we don’t start to bridge that gap we’ll continue to over-treat and under-treat.”
The problem is not simply one of language.
Inadequate communication also leads to “doorknob moments” that are familiar to all healthcare providers. These are times when the patient provides some critical information or asks a key question at the end of a visit just as the clinician is headed out the door and has little time to respond.
In terms of communication with patients, under our current system of healthcare, or “sick” care as some call it, healthcare professionals are trained to instruct, direct, prescribe, and provide “patient education.”
Telling patients what to do, advising, directing, trying to persuade, cajoling, informing, and handing out printed brochures isn’t enough. Patients often leave their medical appointments feeling confused, uncertain, or uncared for. Even when patients think they understand what they’ve been told and believe they are doing the right thing, there are big disconnects between what they do and what their clinicians intend.
One way to solve this problem is to cross-train clinicians in person-centered, relationship-focused communication. Four important components of this style are:
Comfort
Acceptance
Responsiveness
Empathy
Everyone benefits from using an empathic communication style—clinicians, patients, families, and the community. Clinicians can better attend to the human story behind what can easily been seen and measured to help patients become true partners in their care. Having empathy for patients has been shown to consistently improve health outcomes and save time.
Patients are empowered to access their own strengths, skills, and resources; partner with physicians in medical decisions (no decision about me without me”), and take more effective charge of their health and well-being. Families benefit from knowing that everyone is on the same page and has all the resources needed to maximize the likelihood of success. Communities benefit because people are more engaged in their health, so costs go down and well-being goes up.
Let’s return to our original scenario of the patient with hypertension. A clinician cross-trained in good communication skills would be sure to invite the patient into conversation, offering comfort, acceptance, and hope. Asking questions instead of directing or advising would be a hallmark in this shift of communication styles. Questions might include, “What do you understand about hypertension and high blood pressure,” and “What do you understand about the risks of having high blood pressure?” After sharing a list of benefits of controlling blood pressure, the clinician might ask, “What are some of the benefits that are most important to you?
The conversation then could advance to what actions the patient feels ready and competent to take. If a patient mentions that they may want to start getting exercise, suggesting swimming and walking when they have no access to a pool or live in an unsafe neighborhood will fall flat. Instead, in a person-centered way the clinician could help the patient develop a list of options that are uniquely right for them.
What has been your experience communicating with your healthcare providers?
If you are a healthcare professional, how do what do you think about these styles of communication and methods to engage patients?
We would love to hear your opinion, please feel free to leave a comment.
