In the average 10–15 minutes a rheumatologist has to spend with a patient during a clinic visit, limited time exists for extensive dialogue. Yet, taking the time to delve a little deeper by asking a patient questions in order to understand and address concerns could make a big difference in a patient’s care.
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“Too often, a patient may feel [too] intimidated to ask a question to clarify a term we use or may fear embarrassment [and avoid] bringing up a concern that can be related to their condition, such as intimacy issues,” notes Ara Dikranian, MD, a rheumatologist with the Cabrillo Center for Rheumatology in El Cajon, Calif.
Common questions Dr. Dikranian receives from patients address how therapeutic medications may affect them. In addition, information, misinformation or incomplete information a patient may learn from friends or commercials may create concerns that need to be addressed. “Listening to concerns and asking directed questions can make a big difference in establishing a stronger rapport with our patients.”
This rapport can support a stronger connection between the patient and provider that translates to improved care, according to results from a survey of providers and patients. Dr. Dikranian and a global advisory panel of rheumatologists reported the findings in 2016.1
The study elicited important data about how patients and providers perceive interactions, concerns and treatment goals. Although 90% of provider respondents said they were satisfied with their communications with patients, 61% of surveyed patients said they felt uncomfortable raising concerns or fears with their providers.
“Despite rheumatologists thinking we are doing a good job of communicating with our patients, the fact remains that we have limited time for this interaction, and there is much room for improving meaningful dialogue between patients and providers for shared decision making to help patients achieve collaborative treatment goals,” Dr. Dikranian says.
Here are five lessons based on the study findings Dr. Dikranian is applying with his own patients.
1. Be Quiet & Listen
Giving patients the opportunity to talk allows the focus of the appointment dialogue to shift from the rheumatologist’s agenda to the patient, giving them a chance to voice concerns that may be unrelated to their rheumatic condition. Sometimes, these patient concerns, such as a patient experiencing anxiety, depression or related intimacy issues, raise opportunities for physicians to connect patients with outside support.
“These issues can negatively affect a patient’s health and treatment progress,” Dr. Dikranian says. “Yet a patient may not want to bring up [a sensitive topic] unless we are proactive listeners.”
2. Think About Your Words & Be Aware of Your Body Language
“Often, the language rheumatologists use may not be completely understood by patients,” Dr. Dikranian says.
Example: When rheumatologists discuss disease-modifying medications, they often use the term biologics, but may not take the time to explain what the term means. This lack of explanation can leave patients to draw their own associations, resulting in a misinterpretation of how the therapies may help them. Also, when a medication is not working for a patient, a rheumatologist may say the patient is failing their medication. Patients may internalize these words and think they have failed.
Dr. Dikranian says, “We have to acknowledge medical literacy—this doesn’t mean we need to talk down to patients, but we do need to explain care in basic terms.”
3. Confirm Patient Understanding
After explaining a medical therapy or treatment term, it may be helpful for rheumatologists to ask the patient if they understand what was explained.
“I also like to ask the patient to repeat back what I said, so I can [ensure] I explained it in a clear way,” Dr. Dikranian says. “During this dialogue, I am also conscious of my body language, because if my gestures suggest I am concerned with keeping to the schedule, the patient may feel rushed and simply nod yes to information I provide without truly understanding what it means for them and their treatment.”
4. Create Shared Goals & Follow Them
Establishing clear goals and sticking to them is something rheumatologists can incorporate into every visit—no matter how long they have been treating a patient.
“When a patient receives a new diagnosis, this is a perfect opportunity to discuss our shared goals for what we want to achieve with treatment,” Dr. Dikranian says. “Then we can revisit these goals at subsequent visits to discuss our progress with the goals and how we can trend treatment to achieve these goals.”
5. Connect Patients with Additional Support
It’s important to consider how a patient can be counseled and advised by other experts, either another member of the practice’s healthcare team or an outside provider.
“These experts, such as a nurse, nurse practitioner, counselor, exercise therapist or dietician, can address a number of different patient needs [and] can support their overall health and progress with their treatment.” Dr. Dikranian says. “Even connecting our patients with informational brochures and trusted online research support can be helpful.”
Carina Stanton is a freelance science journalist in Denver.
- Dikranian A, Galloway J, Kekow J, et al. Understanding the importance of a patient’s role in the management of RA: Physician- and patient-based survey [abstract]. Arthritis Rheumatol. 2016;68(suppl 10).