In an age where patients turn to chatbots and artificial intelligence for answers to their medical questions, effective human-to-human communication remains essential, says Caroline Tietbohl, PhD, MA, assistant professor of family medicine and investigator with the Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS).
In a recent study published in Social Science & Medicine, Tietbohl and research colleagues at the University of California, San Diego and Didi Hirsch Mental Health Services set out to understand how physicians can successfully reassure patients when they do not have a serious illness.
Using conversation analysis to study the social action of reassurance, the researchers reviewed video recordings from 30 clinical visits representing a range of health concerns and care settings, ultimately concluding that physicians should take advantage of missed opportunities to transform no-problem diagnoses into good news.
“Given that these reassurance components appear to be applicable to a wide variety of concerns, the cognitive load required for physicians to incorporate this strategy into their day-to-day conversations with patients may be relatively sustainable,” they write in the paper.
The findings suggest that small moments during clinical encounters can have an outsized impact. Meaningful communication does not necessarily require lengthy conversations. For example, a physician can turn a computer screen so both clinician and patient view the same information together.
Across the 30 cases, researchers identified three distinct components of successful reassurance: establishing understanding of the concern by asking questions and gathering additional information, describing evidence and sharing their clinical rationale, and explicitly communicating an unproblematic diagnosis or no-problem statement.
In cases where physicians used all three components, patient concerns seemed to resolve quickly and without resistance. When they were not, patients pursued their concern.
“Appealing to the person’s emotions was not effective for reassuring them,” she says. “People go to the doctor because they want your medical expertise.”
Video recordings allowed researchers to observe communication as it unfolded rather than relying on participants’ recollections, something Tietbohl says is critical in studying patient reassurance.
“It’s a huge blind spot for studies” if it’s not possible to observe what is being implemented, she adds. “It’s hard to know what’s happening — and why — and what’s working or not.”
That dilemma is what inspired her to study communication more in depth.
“I wanted to know more — what would you have to say to make a patient feel like they could participate in shared decision-making? What could you say differently? What if changing what you said changed what the patient did — or how they thought or felt? These moments of connection, those are the things that I’m always really drawn to,” says Tietbohl.
Learning how people connect and come to feel like they understand each other “is a meaningful thing to study as a researcher, and also as a human in the world,” she says.
For clinicians and the health care system, there are lessons in Tietbohl’s research findings, including consequences of ineffective reassurance and potential costs incurred when patients keep looking for answers because they don’t feel understood.
Failing to reassure patients during an encounter can leave them feeling unheard, increasing the likelihood they will seek additional opinions or testing. Scale that risk up and spread it across the entire health care system, and there’s a potential for increased costs to the system — just for missing an opportunity to reassure a patient or communicate with empathy.
The findings also suggest these communication practices can be taught.
“Everyone can learn how to do it,” Tietbohl says.