How to Explain Well to the Patient

It begins with listening well. In the words of Sir William Osler (one of the founding fathers of Johns Hopkins) 1, “Listening is unspoken caring.” If one doesn’t truly understand the question (or the concern-behind-the-patient’s-question), then one will not truly be addressing the issue that is at the heart of the matter from the patient’s perspective. Thus, it won’t be possible to answer the question.

Even if the hospitalist offers the most eloquent, compassionate, articulate reply, it won’t truly be a response that is relevant to the patient (the customer).

1. Listen well.

2. Be attentive. Establish a person-to-person connection. Focus not only on the words that the patient uses, but focus also on the body language. Connect emotionally with the patient first. The hospitalist needs to help the patient relax so the patient opens up to the doctor. Connect clinically second.

3. Empathize. When one empathizes, one is demonstrating that s/he understands the patient’s feelings. (For example, “You must be very sad.”) Whereas, when one sympathizes, one is expressing one’s own feelings. (“ I am sorry.”)

4. Discover the “question-behind-the question”, or the concern behind the question. Sometimes a question like, “Why do you have to give me that injection?” may seem like a request for more information about the medication, but it may be an unarticulated fear, “I’m afraid of needles.”

5. Formulate a reply that addresses the patient’s concern first and foremost. It’s hard for patients to really listen well if their fear has triggered their adrenalin. They won’t be able to listen completely until you reduce their anxiety. When patients’ anxieties are reduced, that opens up space in their cognitive ability to receive new information.

6. Reply in layman’s terms, or in language that is understandable by the patient. When a patient asks, “What’s this box connected to me?”, the hospitalist can reply in a multitude of ways. Here’s one way: “That’s a telly box – it detects heart arrhythmias.” This explanation could be improved by using terms more easily understand by the patient like,” This is called a ‘telemetry box’. It’s connected to you to detect any problem with the rate or rhythm of your heartbeat. “

* Sir William Osler was one of the “Big Four” founding professors at Johns Hopkins Hospital as the first Professor of Medicine and founder of the Medical Service there.