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Communication skills needed for patient-centered care include:

- eliciting the patient's agenda with open-ended questions, especially early on
- not interrupting the patient
- engaging in focused active listening

Practice this at least in the first 60-seconds, the so-called "golden minute".

Understand patient's perspective

Understanding the patient's perspective of the illness and expressing empathy are key features of patient-centered communication.

Understanding the patient's perspective entails exploring the patient's:

- feelings
- ideas
- concerns
- experience regarding the impact of the illness
- expectations from the physician



Patient-centered communication - basic skills (click here to enlarge the image).

Empathy

Empathy can be expressed by:

- naming the feeling
- communicating understanding, respect, and support
- exploring the patient's illness experience and emotions

Before and after a diagnosis

Before revealing a new diagnosis, the patient's prior knowledge and preferences for the depth of information desired should be assessed.

After disclosing a diagnosis, physicians should explore the patient's emotional response.

Treatment options

Shared decision making empowers patients by inviting them to consider:

- pros and cons of different treatment options
- no treatment

Instead of overwhelming the patient with medical information, small chunks of data should be provided using repeated cycles of the "ask-tell-ask" approach. Using "tell-tell-tell" does not engage patients.

Example:

1. Ask permission to start a conversation
3. Ask what the patient thinks about their health
4. Ask questions to find out what the patient already knows
5. Tell the patient information in a way that is easy to understand
6. Gauge the patient’s understanding by asking questions after you tell

What Is “Ask, Tell, Ask”? video:



References:

Patient-Centered Communication: Basic Skills. Hashim MJ. Am Fam Physician. 2017 Jan 1;95(1):29-34.
https://www.ncbi.nlm.nih.gov/pubmed/28075109
The 10 Building Blocks of Primary Care - “Ask Tell Ask” Sample Curriculum - UCSF
Ask-Tell-Ask: Simple Technique Can Help Hospitalists Communicate Difficult Messages http://buff.ly/2jeNVIN

R.E.D.E. Model of Communication at Cleveland Clinic. Dr. Katie Neuendorf, Medical Director of the Center for Excellence in Healthcare Communication, describes the foundational program her team developed centered on their own R.E.D.E. model of communication:



R.E.D.E stands for:

Relationship
Establishment
Development
Engagement

Clinicians and patient experience experts at Cleveland Clinic have developed a communication program that could help optimize relationships, engage clinicians, decrease burnout, and boost increase satisfaction. To learn more visit: clevelandclinic.org/clevelandclinicway

The video by one of the experts is below:



CCF Physician Communication YouTube playlist is below:



Related:

Adrienne Boissy, MD, MA, Presents Physician Communication http://buff.ly/27jpNpr
Physician Communication: Model of Communication in Healthcare http://buff.ly/27jpQ4z
Physician Communication Testimonials: Adrienne Boissy, MD, MA http://buff.ly/1TBZMb0

Disclaimer: I am an allergist/immunologist at Cleveland Clinic Florida, and first started working at Cleveland Clinic Ohio in 2005.

Good communication makes our work interesting, richer and deeper. But empathy may dry up over time, hence the need to refresh/recharge periodically.

The most open question is "How are you?" The direction a patient chooses offers valuable information during this first "golden" minute in which you are silent.

Share management plans: "What can we do about this"? Unless you become patient-centered, your patient may never be satisfied with you, or fully cooperative.

Every hospital has a department of reflection. It exists in your mind, don't forget to visit there from time to time.

These are excerpts from the Oxford Handbook of Clinical Medicine. Read more on page 4, Asking questions:



Here is the famous Cleveland Clinic video "Empathy: The Human Connection to Patient Care: Patient care is more than just healing -- it's building a connection that encompasses mind, body and soul. If you could stand in someone else's shoes . . . hear what they hear. See what they see. Feel what they feel. Would you treat them differently?"