Patient-centred communication in five steps

Written by: A.A.M. van Paasen (Angela) 15 December 2023

Every healthcare professional who wants to approach their patients as full interlocutors, to truly put them at the centre of care, cannot do so without good communication skills. Regardless of whether a patient suffers from a hernia, heart failure or mental illness, putting the patient at the centre is important in all cases. They also want to feel that they have a say in treatment decisions. Five tips to make your conversational skills more patient-oriented.

1. Connect

If I have to choose between a grumpy plumber who fixes a leak in my bathroom and a cheerful handyman who does not understand his trade, I know which one I will pick. But tradesmen who can communicate well are in high demand. This is no different in healthcare.

Having a good relationship with your patient is crucial to establishing trust and ensuring good outcomes from consultations. This trust is not just about your expertise: it is also personal. The impression you make on your patient is largely in your control and starts with the way you connect with them. Verbally and non-verbally.

Observe yourself, what kind of impression do you give off, how are you sitting? Do you sit in an open and forward position, are you interested in your patient and do you look interested too? What message does your facial expression communicate? Does it match the tone and mood of the conversation? Do not overdo it. Making eye contact with your patient shows you are paying attention to them, but staring and fixating will backfire. Connecting is a matter of timing.

Doctor standing next to a patient's bed — When you actively listen to your patient, you show that you are engaged and give the other person the space to speak.

2. Active listening

Regardless of how much they like to speak in their everyday lives, patients do not like to take the floor uninvited. If they do, they get - it would seem - interrupted by their doctor after just 18 seconds. This is understandable. As a doctor you know what information you need, you take the lead in the conversation and thus determine the course and content of the consultation. You ask about the patient’s history, pain symptoms and discuss policy. Unintentionally, you thereby emphasise the biomedical aspects of the disease. But what about your patient? They are all too often left with concerns, doubts and questions they cannot voice.

When you actively listen to your patient, you show that you are engaged and give the other person the space to speak. Bite your tongue and encourage the other person to speak by humming and nodding. Ask open-ended questions and do not fill in anything for the other person. Pay attention to what the other person says. Sometimes you hear a word or part of a sentence that you can pick out by parroting. You then repeat what has been said in a questioning tone: ‘Nervous?’ Get to the core: what is the question behind the question? And let yourself be surprised by the answer.

3. Say nothing for a while

People often find silences during a conversation somewhat uncomfortable. Some even take it badly and start coughing, fidgeting of drumming with their fingers. But silence can be golden if you use it well. By remaining silent, you offer the other person the opportunity to think about what they have said calmly and whether they would like to add anything more. If your patient tells a story, shares their feelings and concerns, let them talk. Wait for them to finish - really finish - and then wait another two seconds (count!) before responding and asking further questions. Do not give advice right away. Sometimes listening is enough.

How can dealing with silence help you? It will improve your communication skills, it will also make you a better interlocutor.

4. Work together

According to Shared Decision Making (SDM), or Deciding Together, you and your patient decide what kind of care fits best. The benefits of SDM are significant: patients make informed decisions, are more compliant and treatment is more effective. You need good conversation skills for SDM to succeed.

You discuss medical options, pros and cons, and the consequences of the policy with your patient. By doing so, you can provide clarity above all else. Use clear language, be careful when using jargon, keep your sentences on the shorter side, draw what you mean if necessary and ask the patient if they understand you and if there are any questions regularly. Ask about your patients’ preferences explicitly; otherwise you risk misdiagnosing them.

5. Be open to intercultural differences

As a healthcare provider, you constantly have to deal with patients who have a different cultural or religious backgrounds. This causes misunderstandings, but it can also affect the impact of the care you provide. How do you deal with patients from diverse backgrounds? What if a patient has a different frame of reference? What if they do not want to undergo anaesthetic under any circumstances, will never contradict you out of respect or have different hygiene habits?

Doctor listens to patient — Be open to intercultural differences as a doctor

Just having an open mind is not enough for good intercultural communication. By being more aware of intercultural differences, actively improving your knowledge and optimising your skills and attitude, you will avoid sometimes hilarious but often awkward situations.

Sure, we can all communicate just fine; we do this all the time and have done so our entire lives. But ask yourself: how you speak with your patients? What do you do, why do you do it and could you improve? Then the rest will follow naturally.

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