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How to Understand What Patients Want to Tell You

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Many times, your instincts might tell you that your patient is holding back something and you struggle to read between the lines. You have a feeling that they are not telling you something that is of importance – some symptom, some supplements which they are taking, or something which they are experiencing. It is possible that the patient is not telling you about the medications they have missed or the exercise routine which they have not followed. Or they may be worried about something which they heard about or read on the internet. Patients might also feel lonely, scared or very uncomfortable in a hospital setting and refuse to speak up about it.

They might not understand completely what you are telling them, but do not want to ask you again. As per the National Assessment of Adult Literacy, nine out of 10 adults do not have the required skills and knowledge to use and understand the health information. Many times we assume that the patient has understood and will ask questions, but may not, says Suzanne Rita, MSN, RN, improvement learning network manager for Iowa Health Systems' Center for Clinical Transformations.

How can you reduce the gap in this communication and reach out more to the patient to help them better? Here are a few tips to fill this gap:

Keep it simple – Try to avoid medical jargon, which you normally tend to use while speaking to colleagues. It may be easy for a healthcare professional to understand but for others it may be bewildering, especially those who do not have health literacy. Linda Brixey, RN, president of the American Academy of Ambulatory Care Nursing (AAACN), says that when you speak in a language which they are not able to follow, patients simply nod their head and say 'Yes'.

Plan out and use very simple language to say about the patient's condition and treatment. This language is described as 'living room language' by health literacy manual for clinicians from the American Medical Association. Avoid using 'analgesic' and include the term 'pain killer' and use the word 'high blood pressure' in place of 'hypertension'.

Some patients may not be able to read well but may feel embarrassed to admit it. In such a case giving them a handout to read at home may not be successful. It is better to find another strategy so that what you want to say reaches them without any gaps.

Ask patients to be prepared – Clinicians often have very little time to address all the requirements of the patient. To ensure that all needed information is shared, you can ask the patient to be ready with their questions prior to the visit.

Agency for Healthcare Research and Quality (AHRQ), initiated a "Questions are the Answer" campaign to promote better communication between the healthcare provider and the patient. In this campaign patients were requested to write down their queries and complaints prior to the appointments. You can encourage the patient to make a list of the symptoms, side effects of the medications, or questions, if any. This will speed up the process by adjusting the time based on the questions and concerns. Non-urgent questions can be addressed between medication passes and rounds, if needed.

Making a list gives the benefit of understanding the priorities of the patient. Elizabeth Galik, Ph.D., CRNP, president of the Gerontological Advanced Practice Nurses Association, feels that asking them to write down their concerns will help to understand their goals and thus lead to a better patient outcome. Moreover, asking them to get all the medications and supplements during the visit will help you to analyze them rather than relying on their memory.

Understand cultural differences – We often have patients from a culturally different background where they express their agreement and respect in different ways. This is especially true of non-verbal communication. According to Beth Lincoln, MSN, RN, NP, president of the Transcultural Nursing Society and author of the book Reflections from Common Ground, eye contact is the ideal way, in such cases, to show that you are listening or you are engaged in the conversation. But there are cultures in which healthcare providers are kept in high esteem and patients may give eye contact only sparingly. One should understand these differences to communicate better with the patients. Try to observe the style of the person with whom you are going to interact with. This will help you to see some common ground with that person, says Lincoln.

Never be judgemental – Sometimes what we say or how we say it may appear to be judgemental to patients and this may block the communication flow between the nurse and the patient. Patients who are shy or embarrassed may not speak up and one should be careful while speaking to them and try to refrain from giving personal opinions. What they need is a supportive and open environment to share their questions and responses.

Ask them to teach you – Asking the patient to explain in their own words what you have told them, about a medication or how to test the blood sugar levels, will help to ensure that the patients have understood what you have told them and 'close the loop'. If by any chance the patient does not understand the explanation, you can always rephrase it for them. Teach-back method is not difficult to apply but may need some practice before you are comfortable with it.
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