Talk defuses conflict

Good communication is essential in ensuring patients receive safe care, but it may also reduce the likelihood of patient complaints and claims if something goes wrong. Dr James Thorpe explains more.

We each react differently to challenging situations in life and the same applies to how we react to challenging encounters with patients.

Sometimes these reactions are effective; sometimes they are not and this is true for even the most experienced consultants. 

A recent survey by the Institute of Public Policy Research showed that 31% of British adults have found it difficult to access NHS services during the pandemic, with 12% saying they had pursued private healthcare instead . 

Private practitioners may therefore be seeing patients who have experienced delays and are frustrated or anxious. 

It is important to continually hone and develop communication skills that enable you to consciously choose how you would like to respond to a range of challenges from patients in order to bring about a favourable outcome. 

The majority of complaints and claims are not related to the clinical quality of care a patient has received. 

A relationship breakdown often occurs before the incident that leads to a complaint. Put simply, when something goes wrong, your patient is more likely to make a complaint or claim if communication is poor.

Claims and complaints data, and international research, consistently demonstrate that patient dissatisfaction with their doctor’s communication fuels the majority of complaints, and poor communication and a perceived lack of caring is instrumental in patients’ decisions to sue.

Fewer complaints

But is the converse true? Is being a good communicator and demonstrating caring associated with a lower risk of sustaining patient complaints? 

The answer is ‘yes’: studies have found that positive communication behaviours increase patients’ perceptions of competence and decrease their intention to complain or sue. 

In addition to continuously perfecting your professional skills, remember to also take time to perfect communication and empathy skills. 

It is the combination of both technical and emotional performance that appears to single out the route to ongoing overall excellence as a healthcare provider, and it is essential in reducing the risk of a complaint or claim. 

Patients who are kept informed about their condition or the steps being taken to deal with their issue and feel listened to and involved in the care they receive are more likely to comply with the treatment recommended and less likely to complain if things go wrong.

If you think about a situation where you found a patient challenging, did your emotions in this situation affect how you communicated with the patient? 

Our emotions naturally influence our behaviour, which then impacts on the outcomes of these difficult interactions. 

Everyone perceives some interactions as ‘difficult’ and a host of interpersonal and situational factors can contribute to the perception of difficulty.

Researchers and educators have come to understand that it is the relationship or the interaction that contributes to the difficulty. It is easy to identify or label a patient as ‘difficult’.  

Poorer outcomes

However, research shows how this labelling of a patient affects not only the emotions of the clinician but also their cognitive processes, leading directly to poorer clinical outcomes for these patients.

Other potential outcomes from difficult interactions include increased investigations, decreased patient satisfaction and unmet expectations. 

We have all seen patients who we knew or suspected were receiving over- or under-treatment as a result of interactional difficulties with their doctor. 

Of course, this has implications for the individual patient and for medico-legal risk because of the risk of a complaint and/or claim arising from a breakdown in the relationship.

This is why I believe that, regardless of experience, there is value in taking time to examine how you can handle such interactions in the most effective way.

Several skills can be used to ensure you make a good impression with patients. When interacting with doctors, most patients note their non-verbal skills more than they report on other aspects. 

For example, you rarely hear a patient saying: ‘Their clinical skills were excellent’. You are far more likely to hear patients reporting: ‘She was very kind and empathetic’ or: ‘He explained the process to me very clearly’.

Active listening

By maximising verbal and non-verbal skills, you are able to exert some control over the impression patients create. Doctors who are perceived by patients as caring, kind and focused on patient needs can go a significant way to reducing the risk of complaints.

‘Active listening’ is a term that most of us will be familiar with. This involves fully concentrating on what is being said rather than just passively ‘hearing’ the message, and conveying that to the patient using eye contact or smiling. 

Posture can also help in tuning into certain cues, words and emotions in the patient that may indicate distress and other highly charged emotions. 

Continually honing your communication skills throughout your career will help in defusing difficult patient interactions, reduce the risk of a complaint or claim and ultimately ensure you continue to provide care to the best of your ability.

Dr James Thorpe (right) is a medico-legal adviser for Medical Protection