How can physicians show patients more compassion?

Anthony Orsini, DO

A new survey found that 71 percent of patients feel their physicians don’t show compassion during appointments.

What can physicians do to avoid this perception from their patients?

Anthony Orsini, DO, the founder and president of BBN, is a full-time board-certified neonatologist and expert in compassionate communication in medicine. He has developed a philosophy he calls “The Orsini Way,” which gives healthcare professionals tools to communicate in an effective and compassionate way.

Orsini sat down to talk to Medical Economics to discuss physician compassion. This interview has been edited for length and clarity.

Medical Economics: What causes this feeling that there's a lack of compassion coming from physicians?

Anthony Orsini, DO: I think that it's multi-factorial. You know, physicians and healthcare providers, nurses; I truly believe are very compassionate people. There's no question about that.  I think the far majority of healthcare providers go into medicine for all the right reasons: to heal, to comfort, etc.

But it's, a lot of times the difficulty is conveying that compassion, and so the compassion is there, but for some reason they have difficulties conveying that compassion. And the reason for that is there's several reasons for that. So first one is that we are just not trained as physicians and nurses on how to communicate effectively and compassionately. There's no training and with very little training in medical school, although some medical schools are starting to do it now.

But still, the training is very lacking on how to communicate effectively, and with compassion and communication is the key to not only a patient experience but also to clinical outcomes. So, we know that the majority of medical errors are caused by communication errors, the majority of malpractice lawsuits name poor communication, their lack of compassion, as part of their top three reasons for filing for malpractice.

So, it's the lack of communication and it's also the emphasis that we've been placing, that healthcare has been placing on physicians and nurses to be more efficient, to move faster, and to perform better. And the studies have shown that by doing that you actually, by multitasking, you're actually slowing down. So, the answer to your question is one lack of communication skill, and two is the demands of modern healthcare.

Medical Economics: What are some common stumbling blocks that physicians are running into when trying to better express their compassion toward their patients?

Orsini: The biggest stumbling block is that most of them haven't been trained on how to do that.

So, we get caught up in our daily routine, we are becoming more and more task-oriented, more and more technology-oriented, and often, unknowingly, just forget that medicine at its core is a human-to-human interaction.

And so, for instance, the electronic medical records serve their purpose and are generally a good thing to have. However, the temptation to multitask and type into a laptop at the same time that you're interviewing a patient sends the message that you are really not listening.

There's a study out in Gainesville that showed the average time a doctor interrupts the patient is 11 seconds. So that's incredible. So in our efforts to multitask, we're actually conveying the message to the patient that we're really not listening and that leads to poor communication and is perceived by the patient as a physician is not being compassionate, as you can see in the survey.

Medical Economics: What are some practical tips to try and bridge the gap between the compassion a physician actually feels toward a patient and what the patient perceives?

Orsini: The first thing I'd like to tell physicians is that multitasking doesn't save you time. And that is, you know, what your mother told you a long time ago: Doing something right the first time is actually the most efficient.

So, the techniques that I teach physicians and I've been teaching healthcare providers now for over a decade, there are simple things that you can do to tell that patient that you're listening, but the easiest one is to sit down.

Once you sit down to speak to a patient and look them in the eye and really listened to them, you're telling that patient that I'm here and I'm listening, you have my undivided attention. That doesn't take any time at all to sit down.

The second thing is, listen to the patient without interrupting. Let the patient know that what they're saying is extremely important and then when you're done listening to the patient, the patient's done speaking, use open-ended questions, ask the appropriate questions, and then document later on. Don't try to do two things at one time.

I see many physicians asking questions with the stethoscope in their ear trying to listen to the lungs at the same time. If you were a patient, would you really believe that that position was listening? So, those are two simple things that you can do: not multitask and sit down, ask open ended questions and listen, and the patient will almost always perceive you as being more compassionate and less and hurried, as you can see in the survey that shows that most patients do believe the doctors are hurried, are not listening.

Medical Economics: Why do you think that patients are really striving for this compassion?

Orsini: What patients really desire is a relationship with their physician. It doesn't have to be a long-term relationship. It can be a relationship with an emergency medicine physician that you just met five minutes ago. But patients are coming into last or not because they want to because they have to, they come into the doctor's office because they're not feeling well.

They're feeling vulnerable. They need that human-to-human interaction, and that's what they desire. So, all the technology in the world cannot replace that. And so, so that's what patients are really looking for. And you can build this relationship by just changing a few words and using body language, to really connect and build rapport with a patient. In just a few minutes, it doesn't have to take long and that's probably the biggest misconception about communication with patients is that it takes time and it really doesn’t. If you do it right, it’ll save time.

One of the biggest mistakes that hospitals make is to treat patients as if they were in a hotel and right now I do a lot of work with patient experience and enhancing the patient experience, patient satisfaction scores. A major, major mistake is to take cues from the hotel industry. The difference between a hotel and a hospital is that you want to stay in a hotel. You don't want to be in hospital. So the amenities and all the great beautiful things in a hotel and the workers all saying the same thing at the same time will work in a hotel during a vacation. But again, that patient that comes in hospital is vulnerable. They don't want to be there, and they're looking to really cling and build rapport with everybody who treats them including the nurses.

Medical Economics: Is there anything else you would like to share with our audience?

Orsini: Now, I would just add that, you know, this survey to me really emphasizes the need for more trainings for healthcare professionals to learn how to communicate. We really need to push our resources, financial resources to teach everyone how to communicate with those patients, understand what's important to the patient. And we're getting there but I think that hospitals right now are not putting enough resources into this. And, and we really can improve healthcare by enhancing the communication.

You know, Deloitte put out a study that looked at the financial bottom line of hospitals and patient experience and show that you know, for every I believe it was every 10 percent improvement in patient satisfaction scores, the net margin go up by 1.4 percent. So patient satisfaction is a huge topic right now and if you can improve the way doctors communicate and get this number down, declined to so that patients now say, “no, my doctors don't feel hurried and I feel like I really connected with them,” your patient experience will go up to hospitals will do better financially. And also studies have shown that there's better clinical outcomes. So it's a win-win situation for everyone, if we could just spend a few dollars teaching healthcare providers how to communicate with compassion.