American College of Physicians: Internal Medicine — Doctors for Adults ®


"Anything else?"—The secret to effective communication

From the June ACP Observer, copyright 2007 by the American College of Physicians.

PMC TipsEffective communication results in improved patient satisfaction, increased compliance with treatment plans, improved physician satisfaction, decreased malpractice claims and better patient outcomes. Communication inside the exam room is key. An efficient, patient-centered interview boils down to three very simple communication techniques, as attendees of Internal Medicine 2007 learned at the seminar, "You Can Save 2 Minutes Per Patient."

Information Gathering: Physicians interrupt patients after about 20 seconds of talking, but if uninterrupted, patients rarely speak longer than three minutes. Research also shows that patients present with an average of three complaints, but the first complaint is usually not the most significant.

Physicians should begin the encounter with an open-ended, standard question, such as "Why are you here today?" Then for the next three minutes, the physician should say nothing except, "Anything else?" When the patient finishes, the physician should review the issues and prioritize with the patient what can be covered in the current visit. By actively listening and exhaustively asking "What else?" during the first part of the encounter, the physician can reduce or eliminate the "doorknob" complaints.

Relationship Building: Patients usually judge medical quality not on technical skill but on the patient’s relationship with the physician. Relationship building can be done using the mnemonic PEARLS.

P=Partnership (tackling problems together)
E=Empathy (through good listening)
A=Apology (for being late, compassion for their illness, or the inability to get to the entire agenda today)
R=Respect (for patient choices and efforts)
L=Legitimization (of the patient’s feelings)
S=Support (for the patient over the long haul)

Patient Education: Ask-tell-ask: Ask about the patient’s understanding of the problem, tell them what they should know, and then ask what they expect and how well they understand. If the patient understands the diagnosis, the expectations and the plan, then outcomes are sure to be better.

Handouts from the session, "You Can Save 2 Minutes Per Patient: Improving Efficiency and Enhancing Quality" can be downloaded from the PMC Web site. A videotape demonstrating these techniques can be ordered from ACPonline.

"PMC Tips" is a regular feature on small-practice management from ACP's Practice Management Center.


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