You just spent 10 minutes explaining the intricate details of the hemoglobin A1C to Mrs. Jones. You take a breath and ask, “Any questions?” Mrs. Jones frowns at you and responds, “Do I have diabetes?”
It happens even to the most experienced clinicians. You just don't seem to be able to get your message through to the patient. One tool that may help you engage each patient and ensure understanding is the mnemonic RALLY:
Recognize the communication mismatch. Most patients won't tell you that they don't understand what you're talking about, so position yourself where you can see any changes in facial expression or body posture that might suggest confusion (scowling, blank stares, etc.). The problem may simply be that you're talking to the computer screen, speaking too quickly, or using complex terms, or your patient may need an interpreter or have a hearing or visual impairment. If the communication mismatch continues, take the next step.
Acknowledge the communication mismatch. Say to the patient, “I'd like to make sure you understand what I've just told you. Can you explain it back to me?” Expressing your interest in ensuring the patient's understanding will convey how closely you are paying attention and will stress the importance of the information.
Listen actively to the reply. Pay attention not only to what is said but also to what is not said. Is a particular concept missing? Did you assume the patient knew more than he or she actually does? Does the patient tend to focus on data, the process, the big picture, or feelings?
Learn the patient's preference. A number of formal personality and communication assessments, such as the Myers-Briggs Type Indicator, are useful in business, but these are not very practical in the context of a 15-minute office visit. Understanding the four basic temperaments and noting patient preferences, however, may provide enough insight to help you frame messages more effectively.
• Prefer numbers, graphs, and expert opinions.
• Make quick, rational decisions.
• Want to know “what if?”
• Will bring you a computer printout of all their home-glucose readings (with trends).
• Prefer organized information.
• Need time to process, analyze, and reflect.
• Want to know “what?”
• Will take information home to think about it, and will follow-up to share decisions later.
• Prefer big picture ideas.
• Respond to creative examples and metaphors.
• Want to know “how?”
• Will take your one or two options for management and brainstorm 10 more options.
• Prefer stories and people-based explanations.
• Feel concern about impacts.
• Want to know “why?”
• Will tell you about their grandchildren and their last vacation before talking about any medical concerns.
Yield to the patient's preference. Your tendency, especially if you are stressed or rushed, will be to revert to your preferred communication style. For example, you may prefer numbers and graphs, but if your patient needs stories, you must start there. If you begin with one style and it doesn't seem to be working, try something else.
Eventually, when Mrs. Jones begins to nod, ask questions, and maybe even jot down a few notes, you'll know that you're speaking her language.