Communication Tips for Understanding a Patient
All people speak differently. Some people are fast talkers. Others take their time.
Some people speak clearly – or what is considered clearly in their native language.
For others, it may seem that sounds, words and phrases are jumbled or run together.
For a doctor, this can pose challenges.
For a doctor whose first language is not English, this can be even a bigger challenge.
It is scary when, as a doctor, you are struggling to understand your patients.
You want to be able to give them the best possible treatment.
In order to do that, you need to understand what the patient is going through.
Here are 3 ideas and tips to help you when you have a patient that you just cannot understand.
- Ask to repeat
- Paraphrase
- Ask questions
1 Ask politely for the patient to repeat
It might seem obvious to ask again. That is what we normally do in this kind of situation.
However, in medicine, there is a certain pressure for doctors to be perfect.
You might feel that you should not ask again. That you don’t want to bother the patient with too many questions.
But . . . you also need to get some information from the patient. If you do not ask questions, how will you know?
You can simply ask the patient to repeat what was said.
It should be done politely and in a friendly manner.
Examples of asking to repeat
I’m sorry, but could you say that again. I couldn’t quite catch that.
I couldn’t get that. Would you be able to repeat that, please?
Sorry. I don’t think I am following you. Is there any chance you could say that again?
With all of these – as with any situation – ‘please’ and ‘thank you’ go a long way!
If you are nervous about asking a patient to repeat, think of it differently.
The patient wants help. You want to help the patient. The only way to help is to ask.
If the patient gets angry.
No one wants an angry patient. Yet, this can happen. The patient may be angry already.
The patient may be frustrated.
You can simply explain that you want to help him or her as much as possible, and that you are sorry you are not understanding everything that he or she says.
If the patient is still angry, it might be best to move on during the consultation.
2 Paraphrase What You Know
Before moving on, though, it might be best to consider the next option.
If you understand some words – phrases, even – you can still save the situation.
Here, you can repeat what the patient told you. The patient can then confirm what you repeated.
Paraphrasing is repeating what someone said or wrote in your own words.
Simple paraphrasing uses easy language, rather than complex language.
When you repeat something, you offer the patient the chance to explain more.
When you repeat something, you offer the patient the chance to be clear.
Doing this allows you the chance to :
- Be clear about the patient’s symptoms, concerns, questions.
- Get the part that you missed!
What did you miss? Name of medication? What kind of pain was it?
What was that comment he or she made?
Here are some phrases that can help you out.
Just to be clear, let me repeat what you just said.
Would it be okay to repeat what you just said? Thanks.
In other words, you . . .
Alright, you mentioned that . . .
Key point
Intonation is important.
When you finish paraphrasing – repeating what you listened to -, your voice should go up a bit, as in a question.
Just so we are on the same page, your headache started two days ago after you hit your head in the kitchen? Is that correct?
It is important to have a follow up question right after to end the conversation and lead into the next question.
3 Ask follow up questions
Sometimes you might not be understanding your patient not just because of how your patient speaks.
It could be a matter of the narrative.
The patient may be in mental distress in addition to physical distress. This can cause the patient to speak as he or she thinks, without a clear thought process.
A patient might assume that you know what he or she is talking about – hey, you are the doctor, so you should be able to guess about what I am going through based on only a little information.
Sometimes, the patient may continue to speak and speak about a topic – called rambling – that has nothing to do with the medical condition.
As such, you might not be able to get the whole picture of what the patient is telling you.
At this stage, follow up questions are key.
Follow up questions and statements are conversational techniques to continue speaking, to continue the engagement or encounter.
Follow up questions ask for more information.
A follow up question could begin with ‘Any _?’
Any headache or fever as well?
Good follow up questions use WH words and yes/no formations.
When you were in the kitchen, you said you hit your head. Where did you hit it?
How hard did you hit it? Did you have any problems with your eyes after
Fillers
Fillers are words that are used when we pause or don’t have a clear word or phrase to use.
Fillers are that – they fill spaces in speaking.
Fillers can be real words: I see. Right, right. Well . . . Let me see.
Other fillers can be sounds: mmm hmmm errr uh huh um
It is important to use fillers from time to time.
I would say a good place to use them is when you are listening to a patient. A simple, uh uh, or right, can make all the difference for patient feeling.
Final Thoughts
As a doctor you will encounter many types of people in the course of your career.
If you have trouble understanding a patient – especially if you are an international medical graduate (IMG) – then there are several ways for you to improve the situation.
Ask to repeat.
Repeat what you hear.
Ask follow up questions.
All three can help you with your patient interactions.
If you would like the video version, please check the video above.
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