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Dr Bernard was a National Health Care Scholar and served at a Federally Qualified Health Center in Immokalee, Florida for six years after her residency. She then worked for a large out-patient hospital group before opening her own practice, which she con
Doctors can use the psychological techniques of deep listening and emotional validation to help patients feel heard and understood.
Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The opinions expressed here are that of the authors and not UBM / Medical Economics.
My last article discussed how psychology can help us to cope with the impact negative patient reviews have on our physician psyche.
Today I will take a more proactive approach and share how we can prevent bad reviews in the first place by using the psychological techniques of deep listening and emotional validation to build empathy and improve patient satisfaction.
Even when we spend a great deal of time with our patients or do something really important for them like making a critical diagnosis, or heck, maybe even saving their lives, patients may leave their visit feeling unsatisfied. This can be intensely frustrating for the us since we try our best to care for the patient and simply cannot understand what went wrong.
More importantly, feeling unable to make patients happy leads to physician burnout. Doctors who receive negative feedback from patients may begin to feel a lack of accomplishment in their work, or a sense that what they are doing doesn’t matter. They may also begin to develop negative feelings towards patients, which can cause cynicism and detachment.
The good news is that there is a simple way to improve patient satisfaction-and in return, to improve our own satisfaction as physicians. And no, it doesn’t mean giving in to every patient demand for antibiotics or pain medications. The key is learning how to help patients feel heard and understood, which we can do using psychology.
What leads to patient dissatisfaction?
The biggest cause of dissatisfaction occurs when patients leave the office without feeling that their doctor really listened to them.
Unfortunately, sometimes doctors unknowingly give that impression to their patients. Although we may be listening, it may not always be obvious to our patients as we click away on the keyboard and scroll through computer screens. And with the increasing demands of EHRs, computerized physician-order entry, and mandatory check-boxes, we can become so distracted by our role as data entry clerks and paper pushers that we sometimes lose our focus.
By bringing our attention back to the patient–at least at the beginning of the visit-we can dramatically improve patient satisfaction. The bonus is that when we focus on building relationships with our patients, we will find that we get the information we need from them more quickly, and our office visits become more efficient.
The key to patient satisfaction is learning how to show empathy-that you understand their concerns, and you care. Most doctors do care about their patients, but not all are naturally good at projecting empathy to make patients feel cared about and understood.
The simplest way to show empathy is to start with a smile. Even if you don’t feel happy, smile anyway. Psychology shows us that emotions are contagious, so when you smile at patients, even a brief smile, they will automatically smile back. This alone will make them feel more welcome and happier.
Next, engage with the patient in a small physical way. Shake hands. Touch them on the shoulder or elbow. This type of expressive touch has been shown to improve interactions between physicians and patients.
Sit down at the same level as the patient and look them in the eye. Spend just a few moments making small talk before you start scrolling around on the computer–this helps to build a bond that may help the patient to open up more quickly when you begin discussing health issues. You can ask about the patient’s family or hobbies, upcoming holiday plans, or even just chat about the weather.
When you start to talk about the patient’s medical concerns, really listen to the patient, and demonstrate that you are listening by giving the patient your full and complete attention. This can be very difficult with the EHR–but at least during the patient’s introductory statements, don’t even look at the computer!
As the patient begins to describe concerns or symptoms, avoid interrupting so the patient feels completely heard. Use active listening techniques, such as eye contact, leaning forward, and verbal cues (“yes..,” “go on..” “uh huh..”), to show you are listening. Repeat back what the patient says to you, so to demonstrate you heard and understood what was said.
Now, I know what you are thinking.
“I can’t possibly sit there and listen to everything that the patient has to tell me! I will be there all day!”
First, you may be surprised at how quickly your patient finishes talking if you simply let them talk without interrupting. Studies show that the average patient finishes talking in 92 seconds, and most patients will be done within two minutes.
Also, keep in mind that you don’t have to act today on everything that the patient is telling you. You must simply acknowledge that you have heard the patient’s concerns and say that you understand.
Use emotional mirroring and validation
Imagine you are seeing a patient with a chief complaint of abdominal pain. As you are addressing the abdominal pain, the patient then says: “Oh, by the way, Doctor, I’m also having this really weird pain in my foot.”
If you ignore this “add-on” complaint, even if you cure their main issue of abdominal problem, the patient may go away complaining of that “no-good doctor” who didn’t do anything to help them (because you didn’t deal with their foot pain). On the other hand, if you take the time to deal with their foot pain, now you are running behind for your next patient, who is going to be upset with you. It’s a no-win situation!
But there is a solution! You can quickly help the patient feel heard and understood without taking much time by using the psychology technique of emotional mirroring and validation.
Here’s what you do: Simply repeat back the concern that the patient has stated, check for clarification (making it clear that you understand), and show empathy by acknowledging the patient’s concern. Then redirect the patient back to the main problem at hand (in this case, the abdominal pain).
Start by restating the patient’s concern.
Doctor: “You say that you are having a really weird pain in your foot?”
The patient may respond: “Yes, it comes and goes. It’s not there right now, though.”
Again, repeat the patient’s words and ask for clarification.
Doctor: “So, the pain comes and goes, but it’s not there right now, is that right?”
Patient: “Yes, it isn’t bothering me right now.”
Show empathy by validating the patient’s concern.
Doctor: (with an expression of genuine concern) “Pain that comes and goes can be frustrating-I’m sure that must be uncomfortable when it happens. But since your foot is not hurting right now and your stomach is, let’s focus on that area. We can make another appointment to discuss your foot pain.”
The key to this technique is repeating back what the patient says when validating so that they feel heard and understood, even if you don’t act medically on the information offered right at that moment.
Emotional mirroring and validation can be especially useful when dealing with emotionally charged situations or difficult patients, which we will explore more in the next article in this series.
Rebekah Bernard is a family physician and the author of Physician Wellness: The Rock Star Doctor’s Guide. Change Your Thinking, Improve Your Life. She can be reached at her self-titled site, Rebekah Bernard, MD.