Archive for April, 2009

Six Ways to Have Confident Conversations!

April 16, 2009

conversation

We all want to have great conversations, but we often worry about how we come across with other people.  Worry no more!  Here are six tips that lead to dynamic conversations!

Plan ahead.  Regardless of whether you are planning to see a person for an
 important meeting or going to a larger event, you want to have a game
plan.  Think about what you want to say.  Rehearse your thoughts.

Focus on the other person.  One of the biggest conversation errors I see people make is to focus on themselves.  The other person sees them as self
centered and boring.  However, that does not mean you should not talk about yourself at all.  It is all about balance.  During my conversations with other people, I always monitor that balance.

Start with a great question.  Not sure how to start a conversation?  Use an open-ended question, such as, “Tell me more about your trip to …” or “I heard you went to the expo last week, tell me about your experiences.”

Listen instead of planning your next statement.  When I listen, I pretend I am going to have a quiz on what the other person is saying.  I am listening intensely!

Show enthusiasm.  When listening to people, show that you are interested in what they are saying.  You accomplish this through great eye contact, standing /sitting shoulder to shoulder and having energy in your voice.

Be interesting!  Keep up to date on current events and be prepared to discuss these topics.  If I am going to a party, I am always sure to review what is happening in the world, so I could engage in interesting conversations. However, be cautious with topics such as politics and religion.

Now you are ready for great conversations!  Enjoy!

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Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  To book one of his high-content CME-approved keynote speeches or training programs, visit or call:
http://www.CommunicatingWithPatients.com or call 1-800-677-3256

Visiting Favorite Places Helps People Find Emotional Well Being

April 13, 2009

Palm Trees

I am a member of a listserv and one our managers, Kate, always has
insightful and informative posts.  Kate recently discussed a study which
talked about “favorite places.” I did some research on the study and was
so inspired, I decided to blog about the study!

A “favorite places” study was done through the Department of Psychology,
University of Tampere, Tampere, Finland.  This study first reviewed the
literature on the topic.   Previous studies suggest that favorite places
help reduce stress and stabilize emotions. The current study used a
prospective, experimental design to investigate the hypothesis that a
group of adults instructed to regularly visit their local favorite places
will experience greater daily restoration (AKA, emotional stability) and
fewer self-reported physical symptoms than a group instructed to avoid all
favorite-place visits.

For the current study, members of the favorite-place group were asked to
visit their local favorite places at least once per day on 5 weekdays.
They visited five times, on average, and also reported all other place
visits in a structured place diary. Members of the not-visiting group
visited their favorite place 0-1 times and daily reported all place visits
outside the home. The control group, which was given instructions that did
not mention favorite places, reported all place visits outside the home.
Restorative experiences (assessed on the Restoration Outcome Scale and
including attentiveness, relaxation, clearing one’s mind, subjective
vitality, and self-confidence) and self-reported physical symptoms
(headache, backache, muscle tension and pain) were measured with
structured health diaries using Likert scales.

The study collected data in 2006 and analyzed the data in 2007 and 2008.
The study revealed every day the group visiting favorite places
experienced significantly stronger restorative experiences than the
not-visiting and control groups. The groups did not differ in the amount
of self-rated physical symptoms reported at the end of each day. In all
groups such symptoms decreased toward the end of the week.

The study concluded that visiting favorite places affect subjective
well-being. Healthcare professionals write prescriptions for helpful
medications.  How about writing prescriptions for visiting your favorite
places?

By the way, don’t forget to visit your favorite places!

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Edward Leigh, MA, is the Founder and Director of the Center for Healthcare
Communication.  To book one of his high-content CME-approved keynote
speeches or training programs, visit or call:
http://www.CommunicatingWithPatients.com or call 1-800-677-3256

Giving Patients Medical Information: Tips to Make it Stick!

April 5, 2009

teachingpatients-2

You have a very detailed treatment plan to discuss with a patient.  You go
over all the details.  After the discussion, you ask the patient if they
understood everything you said.  The patient says, “Yes.”  You then
ask, “Do you have any questions?”  The patient says, “No.”  You think
everything is fine and you send the patient home.  Later in the day, you
get a call from the patient’s daughter telling you her mother isn’t sure
how to follow the treatment plan.

What happened?  Everything seemed to be going well, but obviously the
patient did not understand what was being said.  There are ways to prevent
this scenario from happening.

Utilize the “Chunk & Check” strategy.  Break down your information into
manageable “chunks.”  After each chunk is delivered discuss with the
patient their understanding.

Apply the “Repeat Back” technique with patients to be sure of
understanding
.   First of all, you do not want to abruptly state, “OK,
repeat back what I just said.”  Rather, for example, say to the patient,
“I have given
you a lot of information.  Just to be sure you feel comfortable, I would
like to know your thoughts on what we just discussed.”

You do not need to employ the repeat back technique with every patient
encounter.  If you tell a patient to rest for two days you do not need to
immediately ask them to repeat what you just said.  Rather, the repeat
back technique is useful for lengthy complicated matters where there would
be a high likelihood of significant confusion.

Summarize the discussion at the end of the patient meeting.  There is a
famous saying among speakers and trainers that applies here, “Tell them
what you are going to tell them, tell them, and then tell them what you
told them.”  If it important, say it a few times.

Concerned about how much time this process may take?  If the patient does
not understand the instructions, think about how much time it will take
you to call them back or have another visit.  Plus, there is a danger to the
patient’s safety if they are confused by their medical plan.

A little planning creates big rewards — safe satisfied patients.

***

Edward Leigh, MA, is the Founder and Director of the Center for Healthcare
Communication.  To book one of his high-content CME-approved keynote
speeches or training programs, visit or call:
http://www.CommunicatingWithPatients.com or call 1-800-677-3256

Signposting: An Effective Communication Tool!

April 3, 2009

signpost1

Definition of Signposting

The dictionary defines signposting as, “An indication, sign, or guide.” When we communicate with people we need to include these cues for effective dialogue.

Let’s say you are driving down the road in a strange city looking for a building and the streets have no signs. Assuming you didn’t have a GPS, you would feel completely lost. Signs are posted on streets to provide guidance. We need to have these signposts in our conversations to avoid people from feeling lost

Signposting is a technique to help people follow the meaning of what you are saying throughout a conversation. You also help people organize what you are saying to them. I am sure we all have had conversations where people seem to be going in all sorts of directions and we can’t follow them. They are NOT using signposting — they are not guiding us from topic to topic.

Signposting to Open Conversations

Rather than just abruptly starting conversations, signposting helps you make a smooth entrance. Here are some examples of using signposting to begin conversations:

* Today, let’s start by discussing the new project …

* First of all, we need to address the meeting with HR …

Signposting can also be used in the beginning to set the stage for the rest of the conversation:

* Today, we need to address three areas. First, we need to talk about the IT seminar. Next, we’ll address the issues with new office polices. Finally, we’ll review the agenda for the annual retreat.

* I will first talk about your stomach pain, then I will examine you. Afterwards, we’ll discuss treatment options.

Signposting as a Transition Tool in Conversations

Signposting can be used to make smooth transitions from one topic to another.

* It looks like we are now ready to begin discussing the updated employee benefit package …

* I have given you all the data regarding the XYZ project, now I am ready to move on to discuss our quarterly goals …

* Next, let’s review the proposal to add the continuing education programs to ….

Signposting to Close Conversations

This allows for cues that you are completing your comments. If you begin discussing closing remarks without letting people know you are finishing, they may be expecting more information. Here are examples:

* In conclusion, I believe we are now ready to implement ….

* At this time, I would like to summarize our discussion …

I will use signposting to conclude this article! In summary, we have seen that signposting is a powerful tool to help people follow what we are saying. Providing people cues allows for conversations that flow. Add signposting to all your conversations and become a master communicator!

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Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  He is the author of the book, Communicating with Patients (due out in the summer of 2009). For more information about his high-impact communication skills programs, visit or call: http://www.CommunicatingWithPatients.com or call 1-800-677-3256

Great Communication Skills = Lower Risk of Malpractice

April 1, 2009

medicalmalpractice

A friend who worked as an oncology social worker for many years told me of
a pediatric oncologist who was working with young cancer patient.  The
oncologist
accidentally gave her a very large (and potentially fatal) dose of
chemotherapy.  The young girl survived this medical error.  My
first thought — that girl’s parents will immediately go to an attorney.
However, that was not the case.

The oncologist spoke to the girl’s parents and explained what happened.
She said she felt terrible and said, “I’m sorry.”  She also said, “Based on
what happened I think it would be best if your daughter worked with
another oncologist.”  The
parents said, “We don’t want another oncologist.  You have been so
wonderful to our daughter.  You were there holding her hand when she was
ill from the various treatments.  We want you to continue treating our
daughter — we won’t have it any other way!”  By the way, they also told
the oncologist they had no plans to take legal action.

Why did the parents have no intention of pursuing litigation?  One simple
reason
— they liked the oncologist.  In general, people don’t sue people they
like.  We get people to like us through great communication skills.

The June 4, 1997 issue of the Journal of the American Medical
Association (JAMA)
included an enlightening article called,
“Physician-patient communication. The relationship with malpractice claims
among primary care physicians and surgeons.”  The primary objective was to
identify specific communication behaviors associated with malpractice
history in primary care physicians and surgeons. The research compared
the communication behaviors of “claims” vs. “no-claims” physicians
using audiotapes of 10 routine office visits per physician. The study
consisted of 59 primary care physicians (general internists and family
practitioners) and 65 general and orthopedic surgeons and their patients.
The physicians were classified into no-claims or claims. There was
significant differences in communication behaviors of no-claims and claims
physicians in the primary care physicians group (no differences in
surgeon group). The helpful behaviors exhibited by the no-claims primary
care physicians included:

Length of primary care office visit
The study demonstrates a strong
correlation between extra time spent with patients and lower frequency of
malpractice claims. Since patients dislike feeling rushed or ignored,
physicians who are “too busy” to sit down, listen attentively, and respond
to a patient’s questions may set the stage for problems down the road.

Engaging in a dialogue
Physicians should encourage two-way communication that includes:

using orientation statements, which educates patients about what to expect and the flow of a visit.  This includes statements such as, “First, we’ll talk about your stomach pain, then I will examine you, and then we will
talk about ways to treat the problem.”

applying facilitation techniques to obtain patients’ opinions, check for understanding and encourage patients to talk.   These include questions such as, “What do you think is causing the pain?”

using applications of humor, laughter and encouraging statements, such as “I’m happy to hear you are feeling better.” Use of humor and laughter express warmth, friendliness and empathy and builds a bond between physician and patient.

inquiring into psychosocial and lifestyle issues, such as, “You said you went on an anniversary cruise last month, how was it?”

providing information and advice, such as by making a statement like this, “The medication may make you feel sleepy.”   This also includes providing educational literature and suggesting organizations to contact. Imparting information
and advice in a manner that demonstrates the
physician’s genuine caring tends to diffuse patient anger and resentment.

Physicians who have been sued for malpractice often cite “unrealistic
expectations”
on the part of their patients. Encouraging two-way communication helps the
patient develop appropriate expectations about a medical visit, and
prompts the sharing of critical information.

Breakdowns in communication between physician and patient fuel distrust
and pent-up anger. No one wants to feel that their concerns are ignored,
nor that their problems have been minimized or disregarded. Factor in a bad
outcome to the scenario and we are setting the stage for a lawsuit. On the
other hand, effective communication skills tends to enhance patient
satisfaction.

The study identifies specific and teachable communication behaviors
associated with fewer malpractice claims for primary care physicians.
Physicians can use these findings to improve communication
and decrease malpractice risk.

Edward Leigh, MA, is the Founder and Director of the Center for Healthcare Communication.  He is the author of the book, Communicating with Patients (due out in the summer of 2009). For more information about his high-impact communication skills programs, visit or call: http://www.CommunicatingWithPatients.com or call 1-800-677-3256