Doctor-patient communication is a timeless issue, but an important one to consider as we start the New Year.

Taking care of patients with common conditions may seem a bit routine at times. Yet for patients, each medical experience is a very individual, personal event. We need to make sure each patient perceives a uniform sense of high-level medical attention and care at every visit. Miscommunication is one of the most common hurdles we face.

In the setting of an academic dermatology clinic, there are many points at which communication issues become problematic. One of these is the esoteric, jargon-based mumbling that goes on between faculty and resident in front of patients. These communication interactions may impress some patients, while others may find it frustrating and inappropriate.

Choose Your Words Carefully

In any setting, even minor, common comments between the physician and his or her staff may leave patients with a sense of uncertainty. Clearly, saying “whoops” during a procedure — no matter the reason — isn’t going to enhance a patient’s sense of confidence in the process. As Dr. Allan Wirtzer pointed out at an American Academy of Dermatology Regional Course on Practice Management, there are things neither he nor his patient needs to hear. An example he cites is, “Doctor, which of these instruments do you want?” Such innocent remarks may leave patients with the idea that they are not being cared for by a well functioning, experienced surgical team. A little more silence, Dr. Wirtzer suggests, is golden — and, if there is a question, the nurse can hold up both instruments and the surgeon can point to the desired one.

One patient of mine recounted a previous visit during which he was seen by one of my partners for an itchy scrotum, the so-called red bag syndrome. Often patients with the red bag syndrome have subjective symptoms that seem out of proportion to the degree of objective changes in the skin. At that previous visit, the dermatologist said to the patient, in front of a resident, something along the lines of, “Well, you don’t have much there.” I’m sure the dermatologist meant that there was little redness or other clinical changes present. The patient was mortified, however, thinking the dermatologist was talking about the size of his genitalia.

The words we use to communicate ideas and information make sense in the context in which our minds express them. But a patient’s context may be different. We have to take care that our words and instructions make sense in the context in which patients perceive them. Clear written instructions, complemented by clear graphical diagrams, may be the best way to do it.

Steven R. Feldman, MD, PhD Chief Medical Editor

Dr. Feldman is the author of Compartments: How the Brightest, Best Trained and Most Caring People Can Make Judgments That are Completely and Utterly Wrong. Xlibris, Philadelphia, PA, 2009. For information, visit www.compartmentsbook.com.