Subtle signs your patient isn’t listening to you

Alistair Gardiner | September 08, 2021

The research is unequivocal: Positive patient relationships are powerful. They make doctors more effective and lead to better patient outcomes. 

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Doctor in discussion with patient

When it comes to doctor-patient relationships, listening is a two-way street.

Much of the literature surrounding the doctor-patient relationship examines whether doctors are communicating effectively—but picking up on times when a patient isn’t engaged, isn’t listening, is feeling fearful, or has difficulty understanding a doctor, can make a big difference, too.

Here’s a short guide to determine whether your patients are paying attention, and the best ways to reach them when they aren’t, based on studies and advice from health experts.

How to tell whether a patient is listening

According to the US National Library of Medicine (NLM), quality patient education helps patients play a more meaningful role in their care. The process must go beyond one-way instruction from the doctor to the patient. To successfully help a patient reach this point, doctors need to be inquisitive and assess patient needs, concerns, readiness to learn, and any educational barriers/limitations.

Start by gathering clues. Rather than making assumptions about what a patient needs, observe the patient and speak to their care team—not just what the patient needs, but what they want to take away from your visit.

Certain signs will clue you in to patient engagement. Ask your patient about their outlook, attitudes, motivations, and fears. By listening to the patient’s perspectives, you’ll learn which information will resonate. Using open-ended questions can help because they can produce a live feedback loop, empowering you to tailor your approach during the visit.

As noted by the NLM, it’s easier to get where you need to be if you understand your patients’ education and skills. Try using “the teach-back method,” whereby you ask your patients to repeat key information to ensure comprehension.

The AMA sheds further light on important patient cues. There may be times when a patient is unwilling or unable to express their true feelings about their malady or the proposed treatment. In these situations, doctors should watch for nonverbal cues like body language or facial expressions—and always ask a patient to elaborate if you feel that there’s something pressing that they’re holding back. 

Verbal or nonverbal, identifying these cues is simpler when you understand a patient’s underlying needs and values, which may constitute a barrier between the information you share and the information that resonates. Listening and looking for certain cues in their responses is vital in figuring out how (or even whether) they’re processing what you’re telling them. 

Communication tips to improve patient understanding

According to Leonard Reeves, MD, a better patient relationship is a two-way system—listening to patients is the best way to ensure they’re listening to you. Doctors should be aware of any cultural idiosyncrasies and should avoid excess medical jargon. Physicians may want to try the "Four Es”: Engage, Empathize, Educate, and Enlist. The final E is particularly important because it can help a doctor understand patient comprehension. 

According to the AMA, the first few minutes of any clinical encounter are the “golden moments” during which you should focus all attention on reading a patient’s cues so you know how to deliver information in ways that resonate with their unique wants, needs, and cultural identity. During this time, doctors should remain present and use their own body language to reassure a patient that they’re available and paying attention. It may seem obvious, but put your cell phone down so that you aren't distracted.

Permitting a patient’s caretaker or loved one to participate in the conversation can help, too. Doctors should learn about their patients’ support systems and whether they might listen more effectively if other people are present, whether it be clinical staff or a friend or relative. 

Finally, make sure you’re taking into account any patient barriers to education, like low levels of health literacy or numeracy.

And always remember: Better doctor-patient relationships start with better communication, and end with better outcomes.

Not only that, building a trusting and open relationship with patients can go a long way when trying to de-escalate conflicts that may arise down the road. And, as it turns out, it’s also key to avoiding litigation. Read 7 tips to avoid a malpractice suit, according to experts, at MDLinx

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