Skills for Patient Communication PEARLS: Part 5
Legitimation
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 respect is legitimation. Legitimation is an often overlooked area.
What is legitimation?
According to Webster’s Dictionary, legitimation is ‘making something to be accordant with law or established legal forms and requirements.’ However, legitimate also means to be real. With both ideas, legitimation is necessary for great communication.
In medicine, this means making sure that the patient’s concerns and worries are legitimate; in other words, what the patient is experiencing is real, tangible, and needs addressing.
Legitimation means you are honoring the patient by showing you understand that he or she is suffering, and that you are aware of it. It also shows that you will continue to work with them to make sure things improve.
Legitimation can be simply stating that you – as the patient’s doctor – recognize that the patient is in pain, and that the pain is caused by something.
When stating it, it needs to be in the present tense in general. The future tense is okay if you are discussing a procedure.
‘You have pain in your stomach. It is tough for you now, and I will do what I can to treat it.’
‘For your surgery, there will be pain. We will do everything we can to minimize it, and get you back to good health.’
Legitimation is about letting the patient know that the feelings he or she has are normal, appropriate and accepted.
What is important to remember
The patient may be hesitant to speak up about pain, discomfort or worry about a medical issue.
In many societies, men are expected not to show pain. Indeed, men should ‘grin and bear it’. However, pain is real and should not be ignored.
Talking about the pain and addressing it are keys to better patient recovery.
The patient knows that it is okay to express her or his pain, and that you will not judge them as weak, too sensitive or perhaps even faking it.
When it can be used
Addressing the legitimacy of what a patient said can be done at any step.
At the start of the encounter or meeting.
‘You are in a lot of pain I see.’
‘That is painful. It is tough for you.’
In the middle of the meeting.
‘It must have been rough/difficult for you at the time.’
‘I’m sorry you had to experience that.’
When talking about next steps.
‘After the surgery, you will experience pain. We will do everything we can to make it as painless as possible.’
‘Treatment will take time, and you will be frustrated with it. Please know that I will do all that I can to make it a good experience for you.’
Can you think of any other expressions that might work?
How can you change any of the above sentences into something better?
All areas of PEARLS are interconnected. There is no acknowledgment without legitimation or empathy; each approach needs each other in order to work properly.
Remember to ask your patients about what they are experiencing.
Listen to what your patient is not saying. That is a clue as to what to do next.
If something such as pain, trauma, discomfort (mental and physical), worry about anything – it needs to be legitimized.
Avoid using any negative words or comments as much as possible.
When in doubt, always put yourself in the patient’s shoes – how do you want to be treated?
Future Tasks
In your culture, how do you talk about pain and suffering? Is it common to?
How do you acknowledge someone’s pain?
How would you handle the following:
A 6-year old with a sprained ankle.
A 22-year old with a sports-related injury.
A 39-year old with splitting headaches.
In this series: Part 1, Part 2, Part 3, Part 4, 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.
