Answering questions is part of every clinician’s job and day to day routine, whether it’s in the original job description or not. From providing basic patient education to instruction in home exercises or standard procedures in the clinic, therapists often find themselves answering a wide variety of questions. Questions like, “What’s going on with me?”, “What does that mean?”, and “How many times do I have to come here?” are some of the most common that get asked during an initial assessment or consultation (Check out our article on the 5 Most Important Questions here).
How a clinician responds to these initial inquiries sets the tone for the entire course of treatment and, as we will discuss later, can have a lasting impact on the clinical outcomes of treatment by affecting a patient’s expectations [1]. Their answers can even affect a patient or client’s perception of the quality of the care they receive. By building rapport, trust, and clinician-patient agreement, therapists potentially increase the rates of patient or client compliance, which can have a direct impact on the patient’s health, well-being, and outcomes [2].
It’s safe to say that any clinician who interacts with patients or clients on a regular basis should understand the importance of that responsibility and how to effectively communicate his/her answers in a way that increases the likelihood of positive outcomes.
Clinical Implications of How Clinicians Answer Questions
As mentioned earlier, clinician-patient communications not only have a direct affect clinical outcomes and health, but they also have an indirect effect. Every opportunity to communicate with a patient or client provides a chance to build trust, establish rapport, and improve the therapeutic alliance between the therapist and the patient or client [2]. However, that’s only the case if these instances of communication are handled appropriately. Just as how a clinician communicates with a patient can improve clinical outcomes, it also has the potential to harm outcomes or lessen the impact of the care provided to that patient.
To illustrate this point, let’s consider the potential impact of how a clinician answers the question, “Why does my back hurt?”
This seems like a simple enough question to answer. Simply give the patient or client a rundown on the basic anatomy of the back, common problems or dysfunctions that occur, and then wrap it all up with a likely prognosis and recommendations for how therapy should go, what exercises to do, and what activities to avoid. Anyone from a new grad to an experienced clinician could knock that one out of the park, right?
The Impact of Our Words as Clinicians
Though answering the question above seems to be straightforward and simple, how it is answered and the words the clinician or therapist chooses to use can have a long-lasting impact on that patient. Those words can cause the patient to believe that their back is vulnerable, their injury is serious, or that their outcomes will likely be poor. This leads to the patient having mis-guided beliefs about their back, their injury, and their prognosis [3].
As mentioned in our previous article on explaining pain to patients, clinicians have more influence on a patient’s beliefs and perceptions about pain or dysfunction than almost any other source of information. Saying something that may cause the patient to begin avoiding activities because of fear of pain or injury could result in negative clinical outcomes during and after therapy [4]. Again, this illustrates how the words we as clinicians use have a real impact on not only our patients’ perceptions, but also their real clinical outcomes.
Aside from the clinical impact our words have on patient outcomes, there are also non-clinical implications clinicians must consider. How we communicate with patients can also affect the business side of our practices.
Why Answering Questions is Important for Business
Whether we’d like to admit it, healthcare —at least in the US— is run as a business. We can save the debate on whether or not this is a good thing for another time. However the reality is, that healthcare services are treated as a commodity. This means that our potential patients are “shopping” around for healthcare services. Even in the UK, where there is a national single-payer healthcare system, introduction of “pro-market competition” policies resulted in patients making changes in the hospital or clinic they chose to use [5]. Potential patients were required to be provided with information of 5 potential hospitals including clinical outcomes and patient satisfaction prior to undergoing treatment. The results showed that, ““the share of patients bypassing their nearest hospital increased for better hospitals while it clearly decreased for worse hospitals.” [5] Taking cost and price out of the picture doesn’t seem to change people’s drive to find the highest perceived quality and value for the healthcare services they obtain.
Patients Can Shop For Healthcare From Their Computers
The Internet Changes Things
Now, with the informational revolution of the internet, patients have access to clinic and provider reviews, websites of potential clinics, and information about what to expect when it comes to cost, quality, and duration of treatment. Patients make judgments about the perceived quality of services offered by a clinic or provider based on what they find on the internet. This can be great news if you are in a position to communicate to these “customers” in a way that brings them into your clinic doors. It also means that there are countless clinics and centers trying to advertise to every potential healthcare consumer out there. In the vast sea of providers, clinics, and independent clinicians vying for attention from potential patients —or “customers”— knowing how to stand out from the crowd becomes necessary not only to survive, but to grow your business. We need to be able to communicate with our patients and potential patients in such a way as to not become lumped into “commoditized” health services that are judged solely on price.
Creating Distinction in the Market Through Communication
So how can clinics, practices, or individual clinicians use communication to make themselves or their clinics look better or more attractive to potential patients than their competitors? The answer lies in value, or more accurately perceived higher value. You may be a physical therapist offering services down the street from another physical therapy clinic. What will make potential patients choose you over the competition down the road is the fact that those patients perceive the your clinic or practice provides higher value services.
The way you communicate with patients and potential patients creates a point of differentiation between you and your competition. You must ensure that every point of communication with your patients and potential patients is not only distinct from your competition, but reinforces the higher value you bring to the table. To quote a great book by Scott McKain on the subject: “Unless you become vibrant and committed to making your efforts distinct, your customers will move on.” [6] Now, admittedly there is more to creating distinction in the marketplace than simply communicating with your patients and potential patients. If that communication is not backed up by actual value above and beyond your competition, then you’ll still end up struggling. But let’s focus on how to use communication to create distinction.
What do Patients Really Care About?
Understanding Leads to Better Partnerships
In order to understand the best way to communicate with patients, we need to first understand how our patients think, what they care about, and what they want to know. Unfortunately, there tends to be a disconnect between what clinicians believe to be most important in providing quality care and what patients believe to be most important.
Patients typically “want safe, effective, timely clinical care from skilled clinicians who are able to make them feel personally cared for, included in decision making and comfortable.” [7] The reality is that they are making themselves vulnerable to —in most cases— a stranger (that’s you) to get some kind of relief, treatment, or care for some condition or dysfunction that is impacting their day-to-day life. As clinicians, we often forget this fact. We talk a lot about the medical terms, focusing on anatomy, physiology, and prognosis, but leave out the emotional dimension of patient care. This emotional component is the strongest driver for a patient’s overall satisfaction with a clinic or clinician [7]. This is clearly demonstrated by the fact that roughly just 8% of patients consider being provided literature, diagrams, models, or resource websites to be indicative of quality care [8]. While it is certainly important to provide this informational material to patients, clinicians must first and foremost remember that we are treating individuals with unique social and psychosocial needs. Being able to convey that understanding in every aspect of patient communication sets exceptional clinics and professionals apart from the average.
The Important Questions
Understanding the difference between what patients deem as important factors in the healthcare experience and what clinicians deem as important helps us in answering the most important questions that patients have. I have previously written about the 5 Questions every therapist should be able to answer. Though, on the surface these questions may seem simple and straightforward, they provide exceptional (dare I say distinctive) organizations and clinicians an opportunity to not only demonstrate their clinical skills and expertise, but also provide that emotional connection that patients truly desire in the healthcare experience.
For example, a question about what is going on with their particular diagnosis or condition, on the surface, appears adequately answered by a rundown of their diagnosis, prognosis, and recommendations. Clinicians that take it to the next level will weave in patient-specific information, empathy, and communicate it in a way that demonstrates they truly care about that patient and their specific circumstances.
A question about cost could be answered by simply stating the clinic’s given prices or pricing scale. Again, clinicians that stand out take the time to not only provide rote information about the pricing of their services, but take the time to 1) acknowledge the financial impact of receiving services, 2) show consideration for the patient’s time and resources, and 3) ensure that the patient understands that the clinician’s goal is to get them to a position where they are able to take over the recovery process themselves as quickly as possible —not to simply book as many visits as insurance has approved. How we as clinicians answer questions has more impact on a patient’s experience than what the answer is. In many situations, the answer may not change from clinic to clinic. A patient with a rotator cuff injury will not receive drastically different clinical information in any therapy clinic, but how that information is communicated can make a huge impact in his/her overall satisfaction with care and perception of the value and quality of a clinic’s services.
How to Effectively Answer Questions
Let’s wrap up with a few simple strategies for effectively answering questions that our patients or clients may ask. As a clinician, you obviously have a firm understanding of any clinical, anatomical, or physiological components of questions being asked. What we need to remember is that effective communication involves not only understanding our side of it (the answer), but also taking the time to listen to our patients before going into our preprogrammed answer for “XYZ” diagnosis. Especially during an initial assessment, listening during the patient interview process is essential to establishing a strong therapeutic alliance with the patient which can greatly improve both clinical outcomes and patient satisfaction [9].
As mentioned earlier, how we answer our patients’ questions is much more important when it comes to patient satisfaction and perception of quality than the information we provide (assuming you are providing accurate information —this doesn’t count if you are flat out wrong about the clinical aspect of your answer). Because, at the end of the day, any qualified clinician can tell your patient what is going on, the prognosis, and recommendations. What we need to focus on is the value we bring to the table as clinicians. This means highlighting not only our clinical expertise, but also showing our patients that we care about them as individuals. We want them to know that we care about their unique circumstances, comorbidities, psychosocial factors, and ultimately human situations. Because the truth is that’s why we got into patient care in the first place: to make real human connections and to make a lasting impact on our patients’ lives. And how we answer questions is the first opportunity we as clinicians have to make that connection and impact.
Summary
It’s very easy as clinicians to fall into a mindset of simply leaning on our clinical knowledge and expertise when communicating with patients and clients. We rattle off statistics, prognoses, and recommendations like we’re taking a test. It’s easy to take for granted the impact that our words have on out patients —both on their clinical outcomes as well as their psychosocial and cognitive perceptions of their conditions or situations. Clinicians must understand that how they communicate with patients and potential patients has a direct impact on the business side of their clinical practice. In the age of the internet, we as clinicians should understand that our patients can uncover all kinds of information and reviews of our clinics or services. The way we communicate with patients, both in-person at our clinics or online via our websites & blogs has a direct impact on how our patients or potential patients judge the overall quality of our services. Clinicians should take the time to consider what patients deem most important to a great healthcare experience and then weave that into every opportunity to communicate to them. At the end of the day, how we as clinicians communicate with patients and potential patients has a real and lasting impact on their perceptions of our services and the quality of care we provide.
Hopefully this article has provided some valuable insight into the importance of the way clinicians communicate with patients. Maybe it will even prompt some clinicians to take a second look at the overall communication strategy at their particular clinics or practices. Let’s never forget that we are in the business of serving people, not diagnoses.
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References
[1] Mondloch, M. V., Cole, D. C., & Frank, J. W. (2001). Does how you do depend on how you think you’ll do? A systematic review of the evidence for a relation between patients’ recovery expectations and health outcomes. CMAJ, 165(2), 174-179. Retrieved from http://www.cmaj.ca/content/165/2/174.short
[2] Street, R. L., Makoul, G., Arora, N. K., & Epstein, R. M. (2009). How does communication heal? Pathways linking clinician–patient communication to health outcomes. Patient Education and Counseling, 74(3), 295-301. doi:10.1016/j.pec.2008.11.015
[3] Darlow, B., Dean, S., Perry, M., Mathieson, F., Baxter, G. D., & Dowell, A. (2015). Easy to Harm, Hard to Heal. Spine, 40(11), 842-850. doi:10.1097/brs.0000000000000901
[4] Darlow, B., Dowell, A., Baxter, G. D., Mathieson, F., Perry, M., & Dean, S. (2013). The Enduring Impact of What Clinicians Say to People With Low Back Pain. The Annals of Family Medicine,11(6), 527-534. doi:10.1370/afm.1518
[5] Gaynor, M., Moreno-Serra, R., & Propper, C. (2010). Death by Market Power: Reform, Competition and Patient Outcomes in the National Health Service. doi:10.3386/w16164
[6] McKain, S. (2013). Create distinction: What to do when “great” isnt good enough to grow your business. Austin, TX: Greenleaf Book Group. Get the book here.
[7] Torpie, Kathy (2014) “Customer service vs. Patient care,” Patient Experience Journal: Vol. 1: Iss. 2, Article 3. Available at: http://pxjournal.org/journal/vol1/iss2/3
[8] Levine, R., Shore, K., Lubalin, J., Garfinkel, S., Hurtado, M., & Carman, K. (2012). Comparing physician and patient perceptions of quality in ambulatory care. International Journal for Quality in Health Care, 24(4), 348-356. doi:10.1093/intqhc/mzs023
[9] Diener, I., Kargela, M., & Louw, A. (2016). Listening is therapy: Patient interviewing from a pain science perspective. Physiotherapy Theory and Practice, 32(5), 356-367. doi:10.1080/09593985.2016.1194648
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