“Grateful” workshop participant appreciates downstream benefits

Engagement. Empathy. Education. Enlistment.

Academy members who participate in the AAOS Communication Skills Mentoring Program (CSMP) learn to implement these “four E’s” of communication, along with many other effective tools and techniques for improving patient-physician interactions. Through the leadership of CSMP Chair John R. Tongue, MD, and the program’s growing list of mentors, hundreds of orthopaedic surgeons like me are reaping the benefits of improved communication skills—including more satisfied patients, professional liability risk reduction, and an enhanced sense of purpose.

Workshop mentors quickly make it clear that an incremental increase in time spent with each patient is required to integrate this approach into a practice. The prospect of longer patient visits can be disconcerting to orthopaedic surgeons already under stress due to decreasing reimbursement and increasing pressure to maximize the time-money trade-off. While understandable, this fear is unwarranted. In my experience, routine use of these communication skills leads to “downstream” efficiencies in the patient-physician relationship that more than offset the extra time invested up-front.

Office benefits
Orthopaedists who master the four communication tasks of engagement, empathy, education, and enlistment can actually save time through shorter subsequent office visits, less-frequent phone calls from patients, fewer questions/concerns at bedside, and a reduced number of trips to the emergency department.

Patients who feel they’ve had the opportunity to tell their stories to an empathetic physician on the first office visit tend to be much more receptive to education and “enlistment” in the treatment plan, which all make for more efficient visits in the future.

When I take the time during the first visit to explain the consequences of diagnostic tests or conservative interventions, I find that follow-up visits tend to flow more quickly and smoothly. Patients are more apt to want to “move on” to the next step, rather than reiterate history, symptoms, doubts, and concerns.

Any orthopaedic surgeon can appreciate the time savings when a follow-up visit takes less than the allotted time. Some of the longest visits I’ve experienced have not been initial evaluations, but visits when a patient returns with heightened anxiety and confusion about the diagnosis and course of treatment because I failed to outline a plan or explain the purpose for tests or interventions.

As a participant in a CMSP workshop, I learned the following basic tenets of effective patient-physician communication:

• Engage patients by listening to his or her stories, negotiate an agenda for the day, explain what additional information or testing will be required, and orient the patient to the process.
• Convey empathy by using techniques that ensure the patient feels seen, heard, and accepted.
• Educate the patient on the diagnosis and treatment options, and pose questions that will elicit useful information and help determine the patient’s level of understanding.
• Enlist the patient as a partner in the treatment plan.

When patients are empowered through the education and enlistment process, the rare follow-up calls that I do receive tend to be simple, direct requests and questions that are readily and satisfactorily answered by my medical secretary. This creates a level of trust between staff and patient and also enhances the job satisfaction of my staff members.

Benefits continue in surgical suite
On the day of surgery, the time I spent in the office fully explaining risks and benefits, and allaying patients’ concerns almost always pays off with shorter, more pleasant preoperative reviews in the holding area.

Often, patients will remind me of particular anxieties or concerns that I’d previously encouraged or “enlisted” them to feel free to readdress. Such reminders eliminate barriers to communication, increase safety, and reduce risk.

Additional benefits become evident when—invariably—new family members, friends, or clergy accompany the patient on the morning of surgery. As they witness the patient’s clear understanding and comfort with the process, these potential patients will remember me and my practice.

Postsurgery time savings
Time spent on rounds and in the office postsurgery is minimized when patients have a clear understanding of the process going into a surgical procedure—rather than surprise and confusion coming out. In addition to direct efficiencies, the patient’s comfort with the ongoing postsurgical outcome also saves time by eliminating the need for family members to act as the patient’s intermediaries.

When patients feel understood and “in partnership” with their surgeon, they are more likely to communicate with that surgeon first when concerns arise, rather than going to the emergency department (ED) or alternative offices.

Additional “downstream” benefits for physicians who implement these skills include greater patient retention, fewer cancellations, and an increased number of referrals.

Obviously, I cannot provide a statistical analysis of the minute-by-minute time savings or the reduced number of follow-up calls that need my attention. My satisfaction is based primarily on my sense of improved patient-physician relationships, lower stress levels, and reduced risk.

For more information on the AAOS Communication Skills Mentoring Program, visit www.aaos.org/csmp

A.J. Yates Jr., MD, is a member of the AAOS Practice Management Committee who has taken a CSMP workshop.