One of the challenges many practitioners face is that of effectively communicating with patients. Bedside manner is not a skill that is taught in school, although it should be.
People have indicated time and again that they would rather return to a practitioner they felt may not be highly proficient, but who makes them feel valued, rather than a technically efficient practitioner who doesn't listen to or hear them.
Although not all of us are "people persons," we can learn and use tools that can significantly enhance communication. In this article, I will describe several techniques you can use immediately to achieve a better and more immediate rapport with your patients. Some of these techniques may seem common sense, but they are the ones most often overlooked.
TA Position: In the communication model of Transactional Analysis, three positions are outlined: I'm OK, You're OK; I'm OK, You're not OK; and I'm not OK, You're OK. These positions refer to how each individual perceives himself/herself within a given conversation. By default, when a person (A) comes to another person (B) asking for and expecting help, the position of A to B is I'm not OK, You're OK. The healer is in the complementary position of I'm OK, You're not OK. Although this is generally an unspoken truth, people do not like to be overtly reminded of it. Therefore, it is important to attempt to communicate from the equal position of I'm OK, You're OK whenever feasible. This is accomplished by both verbal and nonverbal techniques.
Eye Contact/Expression: When meeting patients in your office for the first time, look them in the eye with a smile and a friendly expression. Your task is to put them at ease within the first 15 seconds. It is within these first few seconds that a person forms initial impressions that are crucial to any relationship.
Greeting: A common error is to not introduce yourself. Even if you are the only one in the room, people need that confirmation to settle their minds. A simple "Hi, I'm Steve" will suffice. Along with this greeting, extend your hand, even to female patients. In a professional context, it is appropriate to initiate shaking hands on an initial meeting. In addition, this simple gesture demonstrates to the patient that as a healer you are not afraid to touch them in an appropriate manner.
Position: Whenever possible, move to their level. When a patient is sitting and you are speaking from a standing position, the subliminal message is one of power and dominance. Initially, this is not a feeling you wish to convey if you want to relax your patient. Encourage your patient to sit at a table, and take a seat with them. When a patient is lying on the work-table, always move to where they can see your face whenever you talk to them.
Listening vs. Hearing: Of our five external senses, three are active (visual, auditory and tactile) and two are passive (olfactory and gustation). Simply put, this means that while we may happen to see something in our line of sight, we usually look for specific objects. Although we notice when something touches us, we usually feel for things. Finally, we often hear noises, but to process a sound or a word, we need to listen. Conversely, with smell and taste, we must wait for the stimulus to come to us. That is why there is no active participle for those senses.
One of the most important skills a practitioner can develop is that of listening. Active listening requires concentration and focus, and it is important to listen to our patients to hear what they are telling us. Many times, a nod of understanding or a simple "uh-huh" is the reassurance patients need to know they are not being ignored. When writing notes, a good practice is to occasionally nod when a patient makes a point to indicate that although you weren't looking at them, you were paying attention to what they were saying. Listening is one of the most powerful tools you can cultivate. When patients feel they have been heard, they feel valued.
Adjust the Frequency: This is a particularly subtle, but powerful technique that will help establish rapport almost immediately. However, you have to listen carefully to your patient. When you ask patients questions that require a few words to answer, listen to the words they use. People use words that reflect their "wavelength." After you make a point, a visual person might say, "I see that." An analytical person might say, "Mmmm, I understand." An auditory person might say something like, "Yeah, I hear what you're saying," whereas a tactile person might use the phrase, "I can grasp that." If you can pick up on those cues and adjust your phrasing to match them, you gain rapport almost immediately. For example, if you are talking with a tactile person, you can ask if they "got a feel" for what you were saying. Often, it is when two speakers use opposing wavelength cues that they walk away from the conversation with the feeling that they didn't connect.
Speak Their Language: There are few things more frustrating than not understanding a conversation. When I was 12 years old, my grandmother passed away from cancer. I called her physician and asked him if he could explain what happened. He talked for about five minutes, using terms I couldn't even pronounce, and when he was finished, I asked him if she got chemotherapy. He replied, quite condescendingly, "That is chemotherapy."
When discussing Chinese medicine with a patient, it is important to remember that with notable exception, they don't get it. They think in terms of Western medicine. So, to say something like, "Oh, you have Damp-Heat in the bladder" or "Sharp pain in the shoulder - could be a problem with blood stagnation," without explaining those terms, is very confusing and/or disconcerting. In the latter case, unless you explain what you mean, all patients will hear is that they have a problem with their blood. It is important to take the time and explain to your patients what you are saying in terms they understand. This means, talk to a patient on their level. Use phrases and terminology respectful of the patient's culture or socioeconomic position.
To continue with the above example, you might explain blood stagnation to a 72-year-old cab driver retiree in different terms than you would to a 32-year-old psychologist. It is your responsibility as both healer and communicator to ensure you are understood. Ask your patients if they have any questions and make sure they feel comfortable asking anything.
In closing, the above techniques are just a few that can greatly enhance communication between practitioner and patient. If you practice them with diligence, such that they become second nature, you will see that your interactions with your patients will become much more comfortable, relaxed and satisfying.
Steven Collins is a licensed acupuncturist in Minnesota. He specializes in tui na, a type of Chinese medical bodywork. He was a paramedic and an RN for 20 years before becoming an acupuncturist.
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