“Communicating with patients is a procedure. Something you’ll do somewhere between 100,000 and 200,000 times in your career. And yet it’s the one thing as clinicians you get so little training to do, in comparison to everything else.” Alan Gunderson, MD, associate professor in Gastroenterology and Hepatology, offered this insight at the beginning of the Provider Communication Program, a half-day workshop sponsored by UI Health Care and organized by the Office of the Patient Experience (OPE). Currently the sessions are offered only via Zoom.
Gunderson, along with Theresa Brennan, MD, Chief Medical Officer and clinical professor in Cardiovascular Medicine, are two of the faculty facilitators of the program, which is available to any health care provider at Iowa. The other faculty facilitators are Vicki Kijewski, MD, program director of the Internal Medicine-Psychiatry Residency and clinical professor in General Internal Medicine and of Psychiatry, and Caryn Berkowitz, MD, clinical professor in Gastroenterology and Hepatology. All of the facilitators establish a supportive environment to try out new skills or polish existing ones.
“These are techniques that are evidence-based. They will help you manage your time better and provide better outcomes for your patients,” Gunderson said to the gathered attendees. Gunderson and Brennan both described benefits from the workshop that were backed by published research, including discoveries like the average patient speaks for about 11 seconds before being interrupted by a clinician. Or that an uninterrupted patient will speak on average for only about 90 seconds.
Though the facilitators do spend some time in didactic mode, most of the sessions are spent in hands-on, observed practice. Small groups and pairs discuss what aspects of patient communications are most challenging and then practice new techniques with a professional simulated patient. After the practice, others in the group offer their feedback as does the simulated patient, from their perspective, what felt helpful or comforting or too rushed. “Adding the actor was one of the recent changes we’ve made to the program,” Gunderson said. “We’re all good at playing the provider in these simulations, but we were finding that the patient role was harder for clinicians to take on.” Attendees noted and appreciated the authenticity the actor brought to the role-playing.
Other recent changes include trimming the length of the workshop from 8 hours to 5 and adding follow-up one-on-one evaluations from OPE coaches who practice “appreciative coaching.” Though these improvements are beneficial, the core lessons on offer continue to hold true. With an emphasis on empathy, establishing rapport, and setting an agenda, Gunderson and Brennan begin the didactic section by describing tools that clinicians can deploy in the opening moments of an encounter to set an effective tone.
A range of specific things in that moment to say and do were suggested, from acknowledging someone’s wait time if appropriate or sitting down, but stress was placed on the words or action coming from a place of sincerity and not a script. “Whatever you choose, you should do what feels natural to you,” Brennan stressed. For example, she said, as a clinician stays alert to a patient’s emotions and looks for moments to connect, they could say something like “You seem sad as you’re telling me this” or “I can’t imagine what that must feel like.” Small group work offers clinicians the opportunity to try these kinds of sentences out to find ones that work for them.
Subtle shifts in phrasing were also practiced. “What questions do you have” vs “Do you have any more questions” may initially seem to be identical but the latter contains a hint of impatience that the compassionate clinician may want to avoid displaying. “Empathy, empathy, empathy,” Brennan counseled. “And when that doesn’t work, more empathy.”
In addition to the refreshers, new insights, and opportunity to practice, attendees also found value in interactions with other attendees. Margo Schilling, MD, gerontologist and clinical professor in General Internal Medicine, said she “appreciated learning about the communication challenges facing others outside my department. Interacting with NICU providers, ENT and EYE subspecialists, and talking with all levels of experienced providers, fellows to professor emeriti, enriched the experience. The group size and diversity is ideal.”
Near the end of the workshop, Gunderson and Brennan returned to the list attendees generated at the beginning of their specific challenges, whether it was breaking bad news or managing expectations. In a couple final simulations, clinicians could put the day’s lessons into practice. Schilling was able to practice talking with someone about why they would need to stop driving, difficult news for anyone to hear. Schilling navigated the frustrated responses of the simulated patient and, in the end, by all accounts of those watching taught others something new as well.