Using PEARLS to talk with and help your patients
Apology/Acknowledgment
Not to be confused with pearls in medicine (small bits of information), PEARLS is a method that doctors can use to communicate with patients.
While there are different approaches to speaking with and guiding patients, PEARLS offers a framework that:
- addresses patient feelings and emotions
- addresses the patient-doctor relationship
PEARLS, used in a communication sense, is:
Partnership
Empathy
Apology/Acknowledgment
Respect
Legitimation
Support
Following empathy, apology/acknowledge is a key factor when communicating with patients.
What is Apology/Acknowledgment
Apology and acknowledgement go hand in hand. In terms of PEARLS, apology means exactly what the word stands for – to simply say you, as the patient’s caregiver, are sorry for something.
When you say you are sorry, you are acknowledging a mistake that you or your institution has made regarding your patient’s care and/or experience.
Why this is important
Your patient has come to you because of a health concern. It could be something minor such as a skin irritation. It could be something life-threatening such as skin cancer.
A mistake that is made by you – or by another member of the clinic or hospital staff – impacts the mental and physical wellbeing of the patient.
By apologizing and acknowledging the mistake or the error, you make the patient feel as if he or she is the center again, and that from then on, the patient will be looked after more carefully.
In doing this, you acknowledge the patient’s feelings and emotions.
Apologizing could be for many reasons.
You arrive 20 minutes late to the appointment. Yes, you were busy with another patient, but the patient waiting has been there for perhaps an hour or more. Waiting can lead to frustration for the patient; this could result in the patient being uncooperative or perhaps rude.
In another situation, you made a mistake with a diagnosis. It can happen; indeed, it does happen routinely. More than likely your hospital or institute has a policy about what to do when this arises. Acknowledging the mistake and apologizing for it is something that should be considered in the context of the policy.
Another possible situation is your patient is frustrated that the treatment is not going well. It has been taking time, and the patient does not see any positive result. Even though you may have explained everything at the start of treatment, you should still acknowledge what the patient is experiencing – disappointment, annoyance, even depression.
The patient needs to feel that her or his situation is important for you.
Ways to Use Apology/Acknowledge
As you are the primary care provider for the patient, apology/acknowledge can be used at any time.
Acknowledging your patient’s feelings and emotions is critical to building a good relationship. The patient will feel that you are taking care of him or her, and that you are serious about successful treatment.
It goes without saying that apology/acknowledge can be used with situations such as, but not limited to,
- Being late for the appointment.
- Not using the patient’s name enough, or even making a mistake with the name.
- Not explaining what the next steps are for the patient (time line, tests, diets, medications, surgery).
- Dealing with setbacks in treatment efficacy and administrational delays.
- Misunderstanding what the patient wants you to accomplish. This could range from just getting advice about what to do about a particular condition to curing the patient’s incurable disease.
A simple apology and an acknowledgment of what happened, what can be done, and what the future will bring can make all the difference for your patient.
Phrases That Might Help
Apologizing
Mr. _____/Ms. _______, I’m terribly sorry to be late. I know it must have been a long time. Thank you for waiting.
Sorry to keep you waiting. You must have been frustrated that it took so long. My apologies for that.
Mr. _____/Ms. ________, I would like to apologize for ____________. It was not my/our intention to ___________.
Please accept my apologies for _________.
On behalf of our staff, I would like to _____________.
KEY 1: Intonation is important here as well. Your tone of voice will make all the difference between your patient believing you are sincere – which you are! – and believing you are just going through the motions.
KEY 2: Maintain eye contact with your patient when speaking. It establishes a connection, and a lot can be learned from eye contact.
Acknowledging
I understand that you feel frustrated with _________.
I understand that you feel disappointed with ___________.
I know that I am asking a lot of you. I also know that you are feeling frustrated/upset/disappointed/uncertain about ______.
Continuing
I will continue to do my best to help you with ________.
I am sorry I gave you the impression I was _______. I am committed to your health and wellbeing, and I would like to move forward with you.
Case Study
Let’s look at the following case study:
- Patient is a 47-year old male suffering from seasonal allergies.
- Patient was waiting for about 45 minutes in the clinic.
- Patient shows signs of irritation at being kept waiting.
Here are some possible phrases:
Mr. ________. I am sorry I am late. I know you must be irritated.
I understand. Again, I am sorry about being late for you.
I know you have some allergies going on. I will do my best to see what is going on, and we can get you settled.
How’s that?
Thank you Mr. ______ for your patience again.
PEARLS Assignment Practice
As each patient will have his or her own worries and fears, in addition to medical problems, it is important to consider how best to apologize and acknowledge them in a clinical setting.
For you, please think about how to acknowledge a problem and apologize to the following patients listed below.
- A 25-year old woman who is struggling with depression and you made a mistake with her name.
- A 52-year old man who was misdiagnosed with a stomach ulcer.
- A 78-year old who has been waiting for the results from a test, but has not received them yet.
Each patient has his or her own feelings, needs and lifestyles. How can you best help each person?
It is important to offer apology and acknowledgment when things go wrong. It is your chance to show that you truly care about your patient in all aspects.
PEARLS is a way to connect with and give your patient the best care you can.
In this series: Part 1, Part 2, Part 4, Part 5, Part 6
This article is not about medical treatment. It is about communicating with patients in English. It is an explanation about the PEARLS concept, and is not an opinion of the company and the author.
