Published 9/1/2009
John R. Tongue, MD; Lewis Jenkins, MBA; Angie Wade

How are your interpersonal skills?

Why patient-centered communication is important

Patient-centered care involves treating patients as partners, involving them in decision-making, and enlisting their sense of responsibility for their care while respecting their individual values and concerns. Orthopaedic surgeons have tended to focus mainly on the technical aspects of caregiving. Most patients, however, feel disengaged with the purely technical encounter.

In a 2008 study, the AAOS found that the public continues to rate interpersonal skills as desirable for healthcare providers to possess—just as they did in comparable research conducted by AAOS in 1998 (Table 1). In fact, having a caring and compassionate attitude is rated as second only to successful medical results as desirable traits.

Orthopaedic surgeons are aware of these patient attitudes, and more than 90 percent of those surveyed agree they are important or very important to patients (Table 2). But, orthopaedists don’t necessarily believe patients experience these considerations with other orthopaedic surgeons. In both studies, orthopaedists perceived that patients would give their orthopaedic surgeons’ performance relatively low ratings on these interpersonal skills. (See “Say what you mean, mean what you say, but don’t say it mean”)

Interpersonal skills in practice
Considered a communication tool, interpersonal skills can be learned, lost, refreshed, and expanded. They are critical to a successful patient-centered practice. Better physician-patient communication is linked to increased patient satisfaction, improved patient adherence to medication and treatment regimens, and improved clinical outcomes. The medical-legal literature also demonstrates the profound influence of communication skills on medical liability, medical error, and litigation rates (
Fig. 1).

Practicing orthopaedic surgeons receive limited formal education in the communication skills necessary for patient-centered care, yet they perform more than 160,000 medical interviews during their careers. One of the greatest challenges for surgeons is figuring out how to conduct effective informed decision-making conversations within the constraints of a busy office practice.

Surgeons may be concerned that proposed models of excellent communication may not be feasible in time-pressured work settings, although time pressure may be as much perceived as real.

Sometimes, the problem of not getting the needed information in a timely manner may not lie with the physician. Patients do not always readily share their ideas, concerns, expectations, or desires for action with physicians. Studies suggest that patients do not overtly express their true concerns in up to 75 percent of acute care visits.

Unexpressed concerns may lead to problems in patient care; for example, they may become subtle barriers to the acceptance of optimal treatment. If patients have unfounded concerns but do not express them, physicians have little chance to correct or modify them. Likewise, unexpressed concerns may contribute to breakdowns in communication that are frustrating for both physicians and patients.

Patients need to understand the importance of adherence to their treatment plan and believe that they can accomplish the tasks required within the plan and be able to measure their progress. In other words, patients need both confidence and conviction that they can successfully accomplish their roles in the treatment plan. According to Ramon L. Jimenez, MD, faculty member of the Communication Skills Mentoring Program (CSMP), “If it takes you a little bit of extra time in the first interview, that’s ok; it probably saves you time in the second.”

Another challenge that physicians face is in understanding communication and interpersonal nuances when treating culturally diverse patients. Implementing a complete clinical care model is not always so straightforward, especially when language barriers and patients’ ethnic/racial backgrounds are considered. Patients may come from a different ‘culture of medicine’ than the one generally practiced in the United States.

One of the greatest challenges to professionalism among physicians is cultural competence. Culturally competent care requires the orthopaedists to be aware, understanding, and inclusive, while managing the increased time and cost required to provide equal care to patients with cultural, ethnic, or language differences.

AAOS resources
AAOS CSMP is designed to reinforce this interpersonal philosophy. This half-day workshop instructs a small group of physicians to communicate effectively within a healthcare setting. To date, hundreds of workshops have been given, and more than 5,000 residents and fellows have participated.

“We can all improve our ability to express empathy, demonstrate compassion, and listen to our patients,” says Dr. Jimenez. Consider planning an Academy Communication Skills workshop for your practice group or orthopaedic department; contact Charmain Rachal to discuss timing.

The AAOS Diversity Advisory Board (DAB) also has a program focused on enhancing physician communication with culturally and ethnically diverse patients. During the Culturally Competent Care Grand Rounds for Residency Programs, a DAB member spends 60 to 90 minutes raising awareness and demonstrating the need for culturally competent care. This program is free to orthopaedic residency programs. To learn more or to schedule a presentation for your program or institution, please email diversity@aaos.org or call Maureen Geoghegan at (847) 384-4164.

The Culturally Competent Care Guidebook provides tips and tools for caring for a diverse patient population. Together with the Cultural Competency Challenge CD, a case-based self-assessment program, it offers a total of 6 AMA PRA Category 1 CME Credits. These resources are free to members and residents and will soon be available online. For a sample of the program, visit www.aaos.org/diversity

John R. Tongue, MD, is chair of the AAOS Communications Skills Mentoring Project. He can be reached at jtongue.md@verizon.net

Lewis Jenkins, MBA, is director of the AAOS marketing department; Angie Wade is the marketing research manager.

Communication pitfalls and pearls