AAOS Now

Published 6/1/2011
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Susan Keane Baker

Practical communication tips

It’s been said that it doesn’t matter what you know if you can’t communicate it. Although that may be less true for orthopaedic surgeons than for a lot of other professionals, communication is nonetheless an essential skill. Here are six practical communication techniques for your communication tune-up.

1. Assess the likelihood of follow-through.
One of the frustrations of orthopaedic surgery is that the patient’s outcome is often dependent on his or her ability or willingness to follow through on the agreed-upon treatment plan. The “chunk-and-check” method of communication can help you determine whether your patient has heard you correctly. After you have communicated one important message—a “chunk” of instructions—you check how much the patient understood by asking “What will you tell your husband about how many physical therapy visits should be scheduled?”

2. Discover similarities, especially with patients from cultures different from your own.
It can be more challenging to assess the patient’s willingness to follow through when the patient is from a culture different than your own. If a staff member is from the patient’s country and/or speaks the patient’s language, consider involving that person as an integral part of your treatment team from the patient’s first visit.

The “iceberg of differences” illustrates the differences that can be seen, such as gender, age, and physical ability, as well as those that are not visible, such as education, talents, beliefs, and life experiences (Fig. 1). Many of the differences, however are actually opportunities to find similarities. When you have a patient from another culture, challenge yourself to discover at least five things you have in common. Investing the time to do this will practically guarantee better rapport.

3. Ensure informed consent.
A consent discussion with patients should involve a presentation of the problem, the alternatives (including the alternative of doing nothing), the risks, the benefits, and your recommendations. You can tell whether your explanation is clear if you ask, “Now that we have discussed the choices with the risks and benefits of each, what would you like me to do?” The patient who cannot answer or responds “Well, I guess whatever you think is best, Doctor” may not be adequately prepared to provide an informed consent.

4. Put the patient first.
When a poor clinical outcome occurs, it is imperative that you not abandon the patient and his or her family. One surgeon routinely advises patients and their families to call whenever they have questions, “whether it is tomorrow, or 5 years from now.” This technique can be especially valuable for family members of deceased patients.

If the patient experiences a poor clinical outcome, you will be far more likely to maintain a valued relationship with the patient and the family if you keep in mind that every action and every statement should be for the benefit of the patient. Don’t let a colleague blame the patient and/or family for what happened. Although your colleague is probably trying to reassure you and ease your distress, verbal statements can be overheard and exaggerated when repeated.

5. Promote teamwork.
Problems occur when someone knows something but doesn’t speak up. Problems are more likely to occur when teams are dysfunctional. Here are three team-strengthening approaches:

  • Be a fanatic about analyzing and addressing communication gaps. Your mantra should be “observation, not judgment.”
  • Find time for team members to get to know each other as individuals.
  • Develop a no-gossip policy and adhere to it. It’s not just the person who gossips; the person who listens feeds the destructive weed as well.

6. Analyze your tone of voice.
The tone of your voice has been linked to the likelihood of being sued. Record yourself as if you are speaking with a patient. If you are concerned that your tone might be dominant or possibly perceived as uncaring, watch and listen to Diane Sawyer, the television anchorwoman. She is widely regarded as having an almost ideal tone of voice—one that demonstrates competency as well as likability.

Some of these practical ideas take more time to implement than others. Which idea will you follow through on first, and what is the next step you will take?

Editor’s Note: Articles labeled Orthopaedic Risk Manager are presented by the Medical Liability Committee under the direction of contributing editor S. Jay Jayasankar, MD.

Articles are provided for general information and are not legal advice; for legal advice, consult a qualified professional.

E-mail your comments to feedback-orm@aaos.org or contact this issue’s contributors directly.

Susan Keane Baker is the author of Managing Patient Expectations: The Art of Finding and Keeping Loyal Patients; she can be reached at susan@susanbaker.com