It’s Not What You Say, It’s What the Patient Hears

From Physicians Insurance

Communication is a core clinical competency. Communication competencies are necessary to build and sustain relationships with our patients, enable patient engagement and to optimize patient adherence to treatment plans and recommendations. Communication is complex and often changing, therefore developing a general understanding of these core competencies can be applied in multiple situations.

Developing communication competencies

Once words are spoken you have no control over how those words are understood. This is particularly challenging in difficult conversations, when there is a natural reaction to become defensive. This means is that the physician or practitioner will have to be deliberate in setting aside defensive mannerisms by engaging in active listening, ensuring the patient is understanding, and using appropriate vocal elements.

Difficult conversations may be met with unintentional meaning and therefore engaging the patient through the following active listening techniques may foster empathy by demonstrating that you are reflecting on the patient’s thoughts and feelings. The patient’s thoughts and feelings are believed, supported, and respected, instead of diminished or challenged. The patient will remember how they felt during the conversation.

• Paraphrasing: Restate the information you received in your own words. For example, “You understood that the medication was going to take two weeks to fully work.”
• Verbalize emotions: Reflect on the patient’s feeling and emotions in words. For example, “This made you feel unsure that the treatment was working.”
• Ask questions: For example, “How are you feeling today?”
• Summarizing: Restating the patient’s ideas, including the feelings they expressed. “You are concerned the medication isn’t working and your symptoms are making you feel uncomfortable.”
• Clarifying: Ask questions to clarify vague statements or restate your interpretation to acquire further clarification. “Was this on the same day?”
• Encouraging: Give space for the patient to keep talking. For example, “This appointment is yours, so we can talk about whatever you’d like.”
• Balancing: Help the patient evaluate their own feelings by asking questions. For example, “How does that make you feel?”

Patient understanding is a huge piece of communication. Medical jargon should be avoided or explained in lay terms. Your words should be simple so if there is a complex issue, consider using visual aids to help explain. Check in with your patients understanding by using frequent pauses and asking questions, especially if explaining a complex process. A patient repeating back their understanding of what you said can also identify areas of needed improvement in communication.

Vocal elements include pitch, inflection, tone, rhythm, tempo, and pronunciation. There are some types of conversations that can be emotional and can impact tone which may result in an unintended consequence where the patient deciphers the message differently than how it was intended to be conveyed. There are strategies that can be used to alleviate fear and facilitate the physician or practitioner’s ability to authentically convey emotions such as caring, empathy, and sincerity. These strategies include engaging in deep breathing exercises picturing talking to a loved one about the incident and having appropriate eye contact.

Body language is equally important in communicating with your patients. Some elements of body language to consider your use of are:

• Blank facial expression (not having an expression deters a physician’s efforts to create rapport and empathy).
• Crossing your arms or legs (can come across to patients as if you are closed off, uninterested).
• Sitting versus standing (standing over the patient while they are seated can be seen as intimidating).

Navigating multigenerational communication

Physicians and patients span generations, and it is imperative that communication preferences are understood for barriers to be removed. While there is no formula for effective and successful multigenerational communication, improved multigenerational communication requires an understanding of what shaped the generation, generational values and communication preferences and expectations. The following are generally recognized characteristics of four generations:

Baby boomers (1945-1964) grew up and were shaped during dramatic social change. They relate to public recognition and respect titles. Their focus is on process.

Generation Xers (1964-1980) grew up and were shaped during political and institutional instability. They relate fairness and define themselves by their broader life responsibilities. They respect ideas more than titles. Their focus is on results.

Millennials (1980-2000) grew up and were shaped by technology and instant gratification. They relate to ways that they can make a difference. They respect skills more than titles or ideas. Their focus is on involvement. Millennials outnumber Boomers. They are high-touch and consumer-centric. They are confident, have high expectations and aspire to make a difference. They appreciate partnerships and open communication.

Generation Z (approximately 1995 – 2010) are digital natives. They grew up and were shaped by access to technology from a young age. They communicate via instant messaging, texts, and social media. Generation Z values ethics, individuality, and independence. Gen Z forgoes labels for self-expression. They are focused on health, the environment, and social justice. They make their decisions in analytical and pragmatic ways. They are the most ethnically and racially diverse.

Understanding intergenerational communication can be rewarding. Here are some ways to bridge the generation gap:

• Active listening: Utilize nonverbal body language to convey listening and understanding.
• Empathy: Try to understand the perspectives and experiences of the patient’s generation.
• Clear language: Slang may not be understood by another generation. Using straightforward language that is clear and simple to understand by any age is best practice.
• Technology: Ask questions and learn your patient’s threshold for technology and preferred use.
• Ask questions: Show interest and appreciation in your patient’s experiences and opinions to reach a meaningful relationship.
• Seek training: Improve your skills in providing intergenerational care through training.

Sex and gender identity in communication

Historically, health care focused on a patient’s sex, their biology. In today’s world, the inclusion of a patient’s gender, which reflects the psychological orientation of a person, matters. As this area grows, we encourage attention to be given to a patient’s preferred gender when communicating. Adding this can benefit your patient’s mental health as well as lead to positive patient outcomes. A patient can feel respected and “seen” or “heard” when you honor their preferred gender while treating their biological needs.

Incorporating cultural sensitivity

While a very complex area, the significant barriers related to cross- cultural communication can be patient safety risks and ethical matters. Culture includes traditions, customs, norms, beliefs, values, and thought patterns that are often passed down throughout generations. Incorporating cultural sensitivity into your medical practice allows you to better understand and meet your patient’s clinical needs. This can aid in positive health outcomes and greater patient safety. A patient’s culture can influence their attitudes and even willingness to disclose information or consent to a treatment. Being culturally sensitive can enhance your trust with patients. In case of a language barrier a medical interpreter should be offered and used and documented in the medical record.

Focusing on the below principles can help improve cultural sensitivity when communicating with your patients.

• Recognize your own ethnocentrism (believing that the customs and practices of your culture are superior to those of other cultures).
• Develop a higher tolerance for ambiguity.
• Reduce the level of evaluation in your messages.
• Prepare your message. The roles and rules of the patient’s culture should drive the communication. Physicians and practitioners should prepare their message by adapting to the patient’s culture.
• Remove assumption. Do not assume that nonverbal communication such as eye contact, gestures, posturing, touch, and physical distance are common to all cultures.
• Seek training and education on diversity, equity, and inclusion to improve skills in providing culturally competent care.

None of us are perfect at communication. Practicing with colleagues, friends, and family to strengthen our skillset and application is recommended. Being aware of our shortcomings in communication is half the battle.

This article was featured in the September/October 2025 issue of WSMA Reports, WSMA’s print magazine.