Physician Communication Quality

During your most recent visit, did this provider show respect for
what you had to say?

QUESTION DEFINITION

This item asks patients to assess the frequency with which the provider demonstrated respect for patient
comments and questions during the most recent visit. The concept of respect is tied to overt behaviors
such as acknowledgment and relevant, non-dismissive responses. The specifics of respectful behavior
vary with ethnicity and culture. In order to respond to this question, the patient must assess how often the
care provider indicated, verbally or non-verbally, that the patient’s remarks were taken seriously. Patients
differ in their sensitivity to such behaviors.

VOICE OF THE PATIENT

This doctor took me seriously. When I told him about the constant pain, he didn’t roll his eyes like some
do.

I don’t think he believed me when I described my pain issues. He told me that they had already given me
the medication that was supposed to help. I don’t care … IT DIDN’T!

IMPROVEMENT SOLUTIONS

Essential Behaviors
 Actively listen. Do not act as though the patient is overreacting. Let the patient tell you how
he or she is feeling. It is important to avoid telling patients how they are supposed to feel.
Show that you care for the patient and the patient’s experiences.
 Maintain an empathetic tone when speaking with patients. Let them know that you have
heard their concerns and that you will do everything in your power to help them.
 Allow the patient to “tell the story” without interruption. The average amount of time a
physician allows a patient to speak before interrupting with a question or observation is
approximately 20 seconds. Patients do not feel this is an adequate amount of time to fully
explain their stories. Actively listening to patients and allowing them enough time to speak
often does not take additional time. (In fact, it may actually take less time in the long run.)
 Avoid interrupting patients; it is a sign of disrespect and disregard. If a patient talks
incessantly, say something along the lines of, “Let’s take a step back and address these
concerns one by one.” Use body language and communication cues to demonstrate interest
and concern in what the patient is saying. This means sitting down so you are at eye level
and leaning slightly toward the patient. Direct eye contact, affirmative head nods, and putting
down the chart while listening all convey interest in the patient.
 Give patients an adequate opportunity to ask questions and explain their concerns or
situations. When patients are allowed to speak and feel like they are being heard, there will
likely be gains in satisfaction.

© 2014 Press Ganey Associates, Inc. 28

  Do not respond to a patient’s question with another question. Instead, obtain more
information. It is helpful to use phrases such as:
 “Well, that depends. Do you notice when that happens?”
 “I can give you an answer after I get a little more information from you. Can you tell
me more about that?”
 Using an empathetic statement and meaning it are two different things. If you tell the patient,
“Yes, I can see how that would be upsetting for you,” but you are looking away and writing in
the chart, you give the appearance of not paying close attention. Instead, maintain eye
contact, use facial expressions to relay your concern and nod your head to show
understanding.
 Sometimes, speaking too quickly can be misinterpreted as a lack of concern and patients
may feel that caregivers are rushing them. Take a deep breath, focus on the patient and walk
into the room with a sense of curiosity about how you can be of service to each patient.

Processes/Operations
 Invest in customer service and communications training. For example, use simulation labs to
reinforce and coach staff on expected customer service and common courtesy behaviors.
Simulation labs mimic realistic scenarios and allow staff to practice interactions and
behaviors.
 Engage in role-play scenarios and evaluate body language and adherence to
standards to create self-awareness in each staff member. For example, ask the
nurse to role-play finding a patient in the waiting area and escorting him to the exam
room.
 Record each team member as they practice their regular patient greeting. Watch the
recording with individual staff members and have a discussion about the positives
and negatives.
 Leaders must be role models for all standards. Support an environment of ongoing
coaching by providing feedback to staff members.
 Have physicians practice their communication techniques with a staff member.
 How does a physician’s body language and tone come across to others?
 Is there compassion? Is there harshness? Is the physician just nodding and saying
“uh-huh”?
 Is the physician open and approachable?
 Is the physician using too much medical jargon?
 Remember the 3 P’s for a physician visit. Be:
 Present
 Purposeful
 Prepared
 Before beginning clinical work with patients, explain everything that is going to happen during
the visit. Be sure that patients are comfortable with the process and ask if they have
additional questions or needs.
 Ask the patient questions throughout the interaction. For example, "Do you have any
pain?", "Do you understand what I am doing?", "Are you okay with what is
happening?” etc.

© 2014 Press Ganey Associates, Inc. 29

  How does your patient population define the terms “show respect?”
 Consider creating patient focus groups on cultural dynamics.
 Understand the cultural diversity of your patients, including communication styles,
family, social relationships, health customs and practices, holidays/holy days, gender
roles, etc.

IMPROVEMENT PORTAL RESOURCES (LOGIN REQUIRED)

UP! Webinar: Targeted Performance Improvement: Improving the Quality of Communication

© 2014 Press Ganey Associates, Inc. 30