How Patient Conversations Create Efficiency

The inpatient consultation service for hematology and oncology is intense. It is busy or busier. When I am on call on the weekend, as the sole physician covering the entire hospital and all the outpatient calls dispatched from the answer service, I do my best to focus and finish my work in the hospital as soon as possible. Any interruption – a message from the answering service, a phone call from a colleague, or a request to see a new patient – I consider all of them as hindrance to my goal of leaving the hospital at a decent hour.

Perhaps that is why whenever I get one of those interruptions, I am not excited about it. In fact, I feel annoyed. Then you add a message that “the family wants to talk to you”. When will the day end?

It was one of those Saturdays. One of the perks about going to the hospital on Saturday mornings is that there is no traffic. I already told myself that it would be a good day before I walked out of the house. I settled in at my usual computer station. As I was doing the inpatient service for the past five days, I knew most patients quite well. As usual, I planned my route – ICU, then the medical floor next to it, so on and so forth. As I was charting, as the day was going according to my plan, the requests for consults rolled in. Three consults in ten minutes. I got this, I thought. Saying it made it more believable.

Talking to the patient or the family is an essential part of the patient encounter, although that is the part that many physicians try to limit, including myself. Having a conversation takes time away from your other work. Some people ask more questions than others. Over the years, I have learned to reclaim more time and efficiency by talking to the patient and family. Yes, it takes time to talk, but you likely gain back the time by having to research less about the patient and getting the point across – such that the patient of the family members will be less likely to call you afterwards.

Effective communication takes practice, and everyone receives a dialog differently. We get to learn how to talk to different people. That is to the point, easy to understand and that is reassuring. After all, we want to establish a relationship with the patient (or the family) that is built in trust and safety. That reassures more compliance and less questions or concerns. Having a discussion allows you to get more information. It also allows the patient to know what is going on and what the plan of action is. The patients get to ask you questions.

Instead of dreading the conversation, either because you are in a time crunch or you simply do not want to talk too much, just do it. Embrace the opportunity. Remind yourself that you are here to help. You are the one leading the conversation by asking the pertinent questions. You get to redirect the conversation so it is to the point and that it is helpful.

Even when you are in a rush, it is always helpful to start the conversation by introducing yourself, followed by asking what the patient understands about their condition. It is best to invite the patient to describe in their own words. That is a great starting point to prompt you how to talk to the patient. If the patient has no clue what is going on, start by summarizing how the patient ended up in the hospital, for example. If the patient expresses full understanding of his diagnosis, then you can start with discussing treatment options.

When I was reviewing the chart in preparation to see a new patient consult, I thought an extensive evaluation was needed to be done after the recent diagnosis of lung cancer. I did not see any records of oncology consultation in the chart. It turns out that the patient sought oncology care in another facility and is already scheduled for treatment. I found this out by simply asking if anyone told him about the results of the bronchoscopy.

Be patient and be attentive while you are talking to the patient, and be mindful of the time. Some patients have the ability to keep the conversation going on and on. It is your responsibility to keep the discussion concise yet meaningful. It is important to be present and now rush it. It is okay

One of the most important parts of medicine is connecting with the patient. Let the patient feel comfortable with you and have confidence in you. Trust is built by being present, not by you talking in a rush. When you are attentive, considerate, kind and focus on helping the patient, that patient can sense it. The more connected you are, the more trust the patient has in you. As you are taking the time to explain and discuss, you will find that patients and their families will have less questions to ask you – because they are not doubting your ability and because you are all on the same page.