The style of the presentation of information is key to its effectiveness. As noted, the physician should establish a balance of power in the relationship, including conducting serious discussions about diagnosis and management strategies when the patient is fully clothed and face-to-face with the physician in a private room. Body language is important during interactions with patients. The physician should avoid an overly casual manner, which can communicate a lack of respect or compassion. The patient should be viewed directly and spoken to with eye contact so that the physician is not perceived as “looking off into the distance” (9).
Laughter and Humor Humor is an essential component that promotes open communication. It can be either appropriate or inappropriate. Appropriate humor allows the patient to diffuse anxiety and understand that (even in difficult situations) laughter can be healthy (43,44). Inappropriate humor would horrify, disgust, offend, or generally make a patient feel uncomfortable or insulted. Laughter can be used as an appropriate means of relaxing the patient and making her feel better.
Laughter is a “metaphor for the full range of the positive emotions.” It is the response of human beings to incongruities and one of the highest manifestations of the cerebral process. It helps to facilitate the full range of positive emotions—love, hope, faith, the will to live, festivity, purpose, and determination (43). Laughter is a physiologic response, a release that helps us feel better and allows us to accommodate the collision of logic and absurdity. Illness, or the prospect of illness, heightens our awareness of the incongruity between our existence and our ability to control the events that shape our lives and our outcomes. We use laughter to combat stress, and stress reduction is an essential mechanism used to cope with illness.
All physicians should appreciate the importance of the art of communication during the medical interview. It is essential that interactions with patients are professional, honorable, and honest. Issues that were reported to be important to physicians regarding patient–physician interactions are presented in Table 1.4. Similarly, patients suggested the importance of many of these same issues in facilitating participatory decision making (45).
Following are some general guidelines that can help to improve communication: 1.
Listen more and talk less.
2.
Encourage the pursuit of topics introduced by and important to patients.
3.
Minimize controlling speech habits such as interrupting, issuing commands, and lecturing.
4.
Seek out questions and provide full and understandable answers.
5.
Become aware of any discomfort that arises in an interview, recognize when it originates in an attempt by the physician to take control, and redirect that attempt.
Table 1.4 Importance Attached to the Patient–Physician Relationshipa a Results of a physician survey of 649 oncologists in regard to patient–physician communication. Modified from Cousins N. Head first: the biology of hope and the healing power of the human spirit. New York: Penguin Books, 1989:220, with permission.
6.
Assure patients that they have the opportunity to discuss their problem fully.
7.
Recognize when patients may be seeking empathy and validation of their feelings rather than a solution. Sometimes all that is necessary is to be there as a compassionate human being.
In conducting interviews, it is important for the physician to understand the patient’s concerns. Given the realities of today’s busy office schedules, an additional visit may be required to discuss some issues in sufficient depth. In studies of interviewing techniques it was shown that although clinicians employ many divergent styles, the successful ones tend to look for “windows of opportunity” (i.e., careful, attentive listening with replies or questions at opportune times). This communication skill is particularly effective for exploring psychological and social issues during brief interviews. The chief skill essential to allow the physician to perceive problems is the ability to listen attentively.
An interview that permits maximum transmission of information to the physician is best achieved by the following approach (10): 1.
Begin the interview with an open-ended question.
2.
As the patient begins to speak, pay attention to her answers, to her emotions, and to her general body language.
3.