Talk the talk

Physician and bestselling author Danielle Ofri, MD, PhD, stresses the importance of communication between doctors and patients at the AAMC's annual meeting.
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It was late on a Thursday night, and Danielle Ofri, MD, PhD, was just closing up her clinic when the phone rang. It was her patient Omar, a 43-year-old with a serious heart condition

“Not again,” she thought. “He always needs something. And he always needs it right away.”

Omar wasn’t feeling well, and he said it was urgent that he see her immediately. She wasn’t free the following day, and the week after was full of missed calls and voicemails between Ofri and Omar.

Much to her annoyance, he arrived at her office without an appointment. She begrudgingly squeezed him in. But as she was escorting him back to the examination room, he collapsed with a thud.

As it turns out, Omar did need to see Ofri urgently, but the lack of clear communication between patient and doctor postponed the much-needed visit.

“I thought, ‘Could I have prevented that if I'd taken him more seriously?’” Ofri said. “When I think back, it’s almost like we were speaking different languages all together.”

Ofri, a physician at Bellevue Hospital and a faculty member at New York University School of Medicine, spoke to an audience of leaders in academic medicine on Monday, Nov. 5, during a session at Learn Serve Lead 2018: The AAMC Annual Meeting about communication between patients and doctors — the topic of her book, What Patients Say, What Doctors Hear.

According to Ofri, bedside manner — often associated with the "kindly affable doctors with white coats and bow ties" — is not simply a bonus quality. It’s a necessity.

“After working on this book and interviewing doctors and patients and nurses and researchers, it dawned on me,” Ofri said. “You can’t be a good doctor without good communication skills. They’re not possible to separate.”

She continued, “The doctor patient conversation is the single most powerful tool we have, bar none.”

And there’s plenty of research to support this, she said. As early as 1965, doctors found postoperative patients had a 50% reduction in opioid use and were discharged three days earlier when their doctors engaged in a simple 20-minute conversation with them about pain management.

But because doctors are spread so thin and have limited time, talking is often kept to a minimum, she said.

She quoted the Greek philosopher Epictetus, who once said, “We have two ears and one mouth, so we can listen twice as much as we speak.”

“He clearly was not a doctor in 21st century America,” she said to a roomful of laughter. “We’re busy. We have lots of things to do.”

It’s easy to falsely believe that a brief conversation about symptoms is sufficient communication, Ofri said. But it is often not.

“The single greatest problem with communication is the illusion that it’s taking place,” she said, quoting Irish playwright George Bernard Shaw.

So how can doctors be better listeners?

One tactic, she said, is basic but effective: give patients your undivided attention for one full minute.

“I think we fear patients will go on forever … we want to turn off that spigot,” she said. But “just give them one minute of full-frontal listening, no computer.”

Proper listening can also sometimes require a mindset shift. One of Ofri’s favorite exercises is to go to the most difficult patient in the ward and ask a simple question that could make them more human in Ofri’s eyes.

For example, she asked a homeless man with substance use issue what his hobby was. He said as a kid, he would skip school to read about Greek mythology on the Jersey Shore. Suddenly, he was a new person in her eyes.

“It’s about taking the time to ask more questions,” Ofri said. “And asking ourselves, how can we make us better?”