There’s no substitute for “connecting” with the patient. Effective communication and demonstrating empathy is a critical component to quality patient care. New technologies such as Electronic Health Records (EHRs) can seem like a barrier for physicians and providers looking to build a connection.
According to a New England Journal of Medicine article (Wolpaw, MD, D.R., Shapiro, Ph.D. D; N Engl J Med 2014; The Virtues of Irrelevance 370:1283-1285, April 3, 2014, DOI: 10.1056/NEJMp1315661), personalized opening comments, “convey that we see patients as unique”, “reveal that we have shared experiences”, “are observant and attending to details”, and “indicate that we are open to a conversation.” All of these help to put the patient at ease and establish a therapeutic relationship.
As healthcare is getting even faster paced, and with an increased focus on productivity and utilization of EHR’s becoming the norm, how can we maintain the “connection” in our encounters with patients? As a practicing physician, I personally have been through two EHR implementations in the ambulatory setting, and currently planning for a third (one in inpatient setting and heading for a second), here are a few tips and tricks that can make a big impact:
- Briefly review the chart prior to entering the room so the beginning of the encounter isn’t dominated by staring at a screen while rifling through the EHR to find basic information. Be clear on basics of their care, including last visit and needs for this one (prescriptions, referrals, etc.). Make sure the patient’s first and last name are known. If a note was made during the last visit of something special in their life, such as a birthday, wedding, or vacation, ask briefly about it. Patients will be more forgiving when we document in the computer if we’ve already made them feel we’re interested and listening.
- Don’t forget your AIDET®.
- An important part of AIDET® is the “A” for Acknowledge. This step helps us make a connection to patient. In addition to eye contact, smiling, addressing by name, sitting down, and shaking hands, opening the encounter with a personalized, genuine statement can help make a connection that will make the rest of the encounter more collaborative and satisfying. It can also make the patient more tolerant when we use EHRs.
- Include EHR as part of the “Acknowledge” step. State why we use it and how it helps in patient care. Specifically indicate that we will periodically turn to EHR to capture important points for the patient’s shared care plan. When we aren’t documenting in EHR, it’s important to have good eye contact. When we do turn to use EHR, be sure to indicate what you are doing. For example, “Just let me capture that important information”, “Just a moment while I include that in your treatment plan”. Use whatever verbiage and phrasing that feels comfortable while acknowledging the transition to and from the computer.
- Don’t forget the “T” in AIDET®: Thank You. Thank the patient for visiting us and close warmly. Don’t let documenting on the computer get in the way of a gracious end to the encounter, complete with eye contact, a hand shake, smile and genuine pleasantry.
- Manage up the EHR (or at least don’t manage it down), just as we manage up the rest of the care team. This helps to create overall confidence in the care provided.
- A great way to engage patients with the EHR is through the use of graphics and visuals. For well child visits, try showing the growth curve. For chronic disease, show trending graphs for blood pressure, weight, A1Cs, or lipids. This is an excellent opportunity to be transparent with our patients and provide detailed explanations that patients appreciate.
- Pay attention to body position in relation to the patient and computer. Is the physical layout of the office conducive so we can sit, talk, and document the encounter with an unobtrusive computer set-up, facing the patient? If not, think about rearranging the room. Consider seating the patient at your EHR station with proximity to both you and the monitor.
- Try utilizing a scribe during patient visits. This allows providers to remain solely focused on the patient while the scribe captures plan of care notes in the EHR. Make sure that you inform the patient of the scribes name and role.
As we move into a more electronic age, let’s not lose the connection to purpose and connection to patients. It doesn’t need to add significant time to a visit and can make a big impact. When we connect, the patient feels it, and so do we. It’s equally as good for the patient as it is for the physician. Happier patients lead to happier doctors. It connects to purpose, worthwhile work and why we got into healthcare in the first place. Connecting adds purpose and meaning, for both patient and doctor.