Approximately 77 million American adults have some difficulty with common health tasks like reading instructions on a drug label, and only 12% of adults have a proficient level of health literacy. The use of medical terminology, collectively known as medspeak, can pose large and unnecessary barriers and lead to poor communication.
"It's very easy to slip into medspeak because we're so used to doing it with our colleagues," admits Somasundaram Subramaniam, MD, MS, a medical oncologist at the Swedish Cancer Institute in Seattle, WA. "There is a definite 'information asymmetry' between patients and physicians."
Inviting patients to ask questions can help you gauge whether the patient understands everything you've said, especially when attempting to explain side effects, says Subramaniam. He says it also gives physicians another chance to clarify the information without resorting to medspeak.
It may also be difficult for patients to express their emotions and open up to their doctors, especially when they're scared, explains Kathryn Pollak, PhD, a professor in community and family medicine at Duke University who also serves as a communication coach for clinicians.
Duke's Department of Medicine offers health communication training to its clinicians because, although several medical schools and residency programs now emphasize communication skills, many attending physicians have never had formal communication training. During coaching sessions, Pollak records doctor-patient encounters, and she says that, in general, physicians are surprised by how many times they've missed opportunities to respond empathically to patients.
"Physicians many times see the emotion, but barriers exist that stop them from responding," she says. "One of those barriers is not having the tools to respond."
Her research has shown that expressing empathy does not lengthen the patient encounter; rather, it makes those visits more efficient. "When the patient expresses an emotion and the doctor does not respond empathically, the patient often expresses the same emotion again and again. That anxiety hasn't gone anywhere."
She says that it can distract the clinician, patients can become flooded with fear and other emotions, and then their cognitive channel becomes blocked. So, she explains, they can't fully participate in shared decision-making. "However, when the doctor responds empathically right away and addresses the concern, the emotion did not come back up, and patients can comprehend the information they need to make an informed decision."
Recognize Meaning Beyond the "Medical Question"
Unfortunately, very few physicians have training in what she calls "decoding" patient language. "Many times the questions patients ask aren't really medical at all," says Pollak, "and, yet, it's so hard sometimes for the doctor not to answer medically."
She says that recognizing the emotion behind the question the patient asks—not the medical question itself—is important. For example, a patient with breast cancer who asks her oncologist about the size of her tumor might not actually care about the exact millimeters of growth—she may be saying she's scared or worried.
Physicians should put themselves in the place of the patient, says Pollak. "Say, 'I will answer that question, but first, you seem worried.' So many times, the 'medical answer' doesn't even come because that's not what the patient cares about. She's saying, 'My cancer is worse. How can this be happening to me?'"
Address the Emotion
Pollak also says that the peppering of questions is a clue that something else is on the patient's mind. If patients or their caregivers have asked several questions in relatively rapid succession, then it's very likely they're anxious or scared.
"Express empathy as soon as you see the emotion and address it immediately, and then you can get on with the treatment plan," says Pollak. "It can be a single phrase: 'That sounds really hard, and you sound scared.'"
Ultimately, "the central message is empathy," she emphasizes. "Do your best to try to understand the perspectives of patients. Even when you're wrong, they will appreciate your attempts. They remember so much more about how they felt rather than what you said."