BLOG: Open communication to build trust, improve treatment outcomes

When caring for patients with gastrointestinal disorders, good communication is key — without it, patients can be left in a vulnerable state not having the information they need to manage their disease.

This can have the effect of increasing uncertainty and distress, when people do not know what to expect.

We must communicate well with newly diagnosed patients in particular, help them feel relaxed and comfortable, and really hear the information to understand their condition. Without their acceptance, communication many times breaks down, patients don’t get the messages they need in terms of treatment and adherence falls apart.

I look at my job, even outside of being a GI psychologist, as enhancing and streamlining communication between a care team and their patients.

Effect on quality of life, treatment

As mentioned before, problems with communication often arise and have a determinantal effect on a patient’s quality of life and treatment outcomes.

First, there needs to be an element of trust when caring for a patient — and we can break that trust right off the bat if someone doesn’t feel heard or understood. These feelings push them into a place where they no longer hear their provider’s health messages or adhere to their treatment plan. It also can increase stress which can further distress related to symptoms and increase chances for treatment complications.

I have met with patients at their third or fourth treatment center who have experienced providers telling them, “This is all in your head” or “We’re not finding anything.” Especially with disorders of brain-gut interaction, this type of communication can hinder a patient’s treatment, diminishes trust and elevates stress, all of which can have a negative impact on quality of life.

Create an open space for discussion

When I first meet a patient, I always make sure to review their electronic medical record, because I want to know what their physicians have discussed with them before I walk into the room.

After my initial introduction, I set up an open space where people feel free to communicate. I ask, “What have you been told about your diagnosis?” or “What do you understand?” If a physician has just left a room, I may even say, “What did you hear?” because I want them to share their understanding of what is going on.

I further foster that communication by answering complicated questions, helping patients find resources and, more importantly, figuring out how to increase communication with the team, helping patients get the information they need in a sustainable way.

Reviewing a patient’s record is important, because it is good to know what the treatment plan is, what the patient has been told by all disciplines, and be able to see how different disciplines with the team frame the patients problem. This allows for not only a better understanding of the patient’s problem, but also the ability for all members of the team to reinforce each other’s treatments and message. When a message is heard from multiple members of treatment team, this can increase trust in treatment overall and improve outcomes such as adherence to the treatment plan.

Allow patients to be emotional

When it comes to speaking with patients beyond the initial EMR review, I recommend making things as easy to understand as possible. Patients don’t always understand medical terminology.

It can be difficult to talk to someone about a lifelong condition we don’t yet have a cure for. People may get upset, which is natural. One of the questions I get most frequently is what to do if someone starts crying. I tell them it is a normal response and ask what they needed the last time they cried. Usually, the answer is that they just want someone to sit with them for a bit. And we can do that. We can allow this person to have a moment, as opposed to shutting down communication and causing panic.

Bottom line: It is OK for patients to cry. We need to be honest in our communication and deliver information in terms they understand — and then sit with the discomfort that inevitably comes with it. It is important to note, that this does not necessarily mean sitting for hours. Many times just a minute or two allows for people to feel heard and changes the relationship with the stress they experience. One problem with stress is the less we want it the more it is there. If we create spaces like this in treatment we are teaching patients that the emotions they experience are part of living with a digestive disease and they have the ability to experience them. This reduces the fight with emotions, leading to decreased distress long-term, and increases trust and perception of care in the treatment team.

Tips for improving communication

Ask your patient what they need and what information you can provide.

Don’t be afraid of emotional reactions — emotions are a natural part of this.

Be able to communicate in a way that someone really understands, in a way that is digestible for the person you’re working with.

If a patient starts looking lost, it’s OK to take time to slow down.

Making sure your patient knows you are there for them builds trust in the medical team, opens communication and allows for better treatment outcomes. Good communication is one of the most important things you can cultivate.