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Apr 27 2011

Five steps to effective communication

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Communication—and its antithesis—miscommunication, are the determinants of professional effectiveness; of patient and professional satisfaction; therapeutic adherence; errors and more. Effective communication is not a gift; it is a teachable, learnable skill. Is there a simple, easy secret to good communication? Of course not. However, there are proven strategies that will enhance the probability of achieving more harmonious and effective therapeutic relationships. Here are five basics:

Devote CME Hours To Communication
One author said failing to communicate effectively is like a surgeon ignoring a bleeder in the operative field. Don’t be that surgeon! Learn, develop and refresh communication skills just as you do your clinical skills. Begin by viewing the I*CARE videos at or the doccom videos at Make a point of attending communication-related sessions when you attend specialty conferences.

Listening Is Kindness
The noted surgeon Charles Mayo reportedly observed that none of us is truly a physician until we, ourselves, experience pain. The loss that accompanies illness and injury is treated with listening, empathy, friendliness, warmth, and concern, qualities that accrete more gradually than our diagnostic and therapeutic skills. Practice listening by allowing your patient to state his chief complaint uninterrupted, while maintaining eye contact. Listening creates a virtuous circle: It communicates caring to our patients while we learn understanding that enables us to help our patients in meaningful ways.

The Environment Speaks
Patients gravitate to settings that respect their dignity and time. The atmosphere you establish within your practice communicates itself to your patients. When you respect the dignity of your colleagues and staff, the result surrounds your patients and is self-reinforcing. When we project our frustrations onto staff and colleagues, like spreading waves on a pond, our patients feel it, too. Whatever comes at us each day, we must meet it with resilience, balance and fortitude.

Be A ‘Kind Landlord’
The writer and literary critic Anatole Broyard wrote that his ideal doctor could enter his condition and look around at it from the inside “like a kind landlord, with a tenant, trying to see how he could make the premises more livable…” Recognize that the world of medicine is largely opaque to patients. Orient your patient to it by giving her clear explanations of what you are doing and why during all phases of evaluation and treatment. Especially, before you put your hand on the doorknob to leave, if you pause and say, “Is there anything else before I go?” your patient may grasp the chance to say what’s been hardest for her to bring up. Be a kind landlord and patients will find it easier to speak.

Care For You
Constant changes to practice models increase the pressures of our demanding profession. Burnout can be the result. An exhausted and depleted physician is more likely to make errors, both communication and medical in nature and to experience diminished fulfillment and satisfaction, both professionally and personally. Pursue, learn, and practice vital, satisfying self-care strategies—discover activities that restore and refresh you. Replenishing yourself is one key to having the resilience and compassion to discern what to say and when or how to say it.

Dr. Akwari’s health care consulting firm, A.M. Akwari LLC, is co-sponsor of Strategies for Effective Medical Communication, a 7-hour CME course offered through WakeAHEC several times each year. The next course offering is September 10, 2011.
Contact Dr. Akwari at .(JavaScript must be enabled to view this email address).

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