12.2 Communicating With Patients: Building Trust and Rapport
Katie Baker
Healthcare providers communicate with patients for a variety of reasons. You may discuss test results, lab findings, or new complaints with your patients. Additionally, you may work with patients to develop a plan of action involving a multidisciplinary team of providers. In all of your communications, compassion and empathy should be your top priorities. Every communication has the potential to either build trust and rapport or lead to distrust and a breakdown in the provider-patient relationship.
In this section, we will explore how to communicate with diverse patient populations. This may involve using assistive devices to communicate with individuals who are deaf or hard of hearing or those who are mute. It may also include communicating with patients who speak a different language through a medical interpreter. We will discuss how to access resources that your healthcare organization may already have in place to support patient communication.
It is important to note that most patients do not have the background to understand medical terminology. Therefore, using understandable and accessible language is essential when explaining healthcare options and diagnoses to patients and their families. In some instances, a patient advocate may be helpful in supporting the patient and their family in navigating their healthcare, including helping them understand the information being shared by their providers.
Finally, the emotional content of the conversation between a provider and a patient is crucial to consider. Delivering unexpected bad news or the negative prognosis of a serious illness requires a gentle approach. Likewise, joyful outcomes such as a healthy birth or positive treatment results require providers to express empathy with the patient and their family. Emotional intelligence, which includes the ability to connect interpersonally and regulate one’s own emotional expression, is a key skill for every healthcare provider.
Communicating With Diverse Patient Populations
You may encounter patients who require specific communication accommodations, such as interpretation services or the use of assistive devices. In these instances, it is the provider’s responsibility to ensure that all communication is clear and understood by the patient. In this section, we will discuss the legal responsibilities of healthcare organizations regarding communication assistance, as well as examples of assistive devices you may encounter. We will also cover how to access communication assistance in Washington State.
Federal law requires healthcare organizations to provide medical interpreters at no cost to patients. Relevant laws include the Americans with Disabilities Act and Title VI of the Civil Rights Act of 1964 (Washington State Health Care Authority, n.d.). In 2000, President Clinton signed Executive Order 13166, which mandates all organizations receiving federal funding to provide interpreters for their clients (Interpreter Training Programs, n.d.).
In addition to language barriers, cultural differences can also affect communication between patients, family members, and providers, as well as influence healthcare expectations and decisions. For instance, some religious beliefs may prohibit certain medical procedures (such as blood transfusions) or result in refusals of care. Other cultures may require that medical decisions and provider discussions be directed to the oldest male in the family, rather than the patient themselves. It is essential for providers to be aware of, and sensitive to, these culturally-based preferences.
In Washington State, the law allows the government to provide spoken language and sign language interpreters (referred to as Language Access Providers, or LAPs) for patients enrolled in Apple Health/Medicaid. However, this provision does not extend to inpatient hospital visits, nursing homes, administrative services, or communication for family members (Washington State Health Care Authority, n.d.). For privately insured or uninsured patients, healthcare organizations must supply their own LAPs if they receive federal funds, such as for Medicaid or Medicare.
Even when patients primarily speak English, other communication barriers may exist, such as speech and hearing disorders or memory issues. It is important to recognize that not all individuals who are hard of hearing or deaf can use sign language or lip-read proficiently. Additionally, relying on lip-reading or other methods to bridge communication gaps can be mentally exhausting for the patient.
Patients may use assistive listening devices, such as hearing aids, or augmentative and alternative communication ( AAC)devices, such as speech-generating devices or picture boards, to help overcome verbal communication disorders. Patients with memory loss or dementia may use tools like scrapbooks or picture boards to assist with recall. Providers should be prepared to engage with these patients honestly, patiently, and with compassion, recognizing the extra effort required on their part to communicate effectively.
Getting Help With Communication
Although there is no one official language in the United States, English remains the primary language for provider-to-provider communication and patient discussions in healthcare settings. This creates challenges when a provider is unable to communicate effectively with patients for whom English is not their primary language. In small clinics or organizations without a standing relationship with a medical interpreter or Language Access Provider (LAP), there may be a temptation to rely on bilingual staff members or even a patient’s family members. However, this practice is discouraged for several important reasons (Interpreter Training Programs, n.d.).
Using bilingual staff members is problematic because many staff members are already burdened with their own job duties and may not possess a sufficient command of medical terminology in multiple languages. Additionally, they may lack awareness of cultural differences and the ethical considerations involved in medical interpretation. While bilingual staff members can sometimes be helpful, especially in urgent situations, it is important that they are comfortable with medical terminology in both languages and are appropriately compensated for translation services.
Relying on bilingual family members also has its drawbacks. They may not fully understand both languages, particularly when it comes to medical terminology, and can face challenges similar to those of bilingual staff members. Family members may also be emotionally distressed due to the patient’s illness, which can affect their ability to interpret accurately. In some cases, they may alter the interpretation based on their relationship with the patient. For example, children may feel uncomfortable discussing sensitive topics, such as reproductive, digestive, or urinary health issues, with their parents or grandparents, and may avoid asking certain questions out of respect or embarrassment. For these reasons, using family members as interpreters should be viewed as a last resort, particularly when professional interpretation services are unavailable.
In Washington State, the Health Care Authority provides LAPs for spoken and sign language services for providers serving Medicaid patients through its website. The site also offers resources for providers working with privately insured patients. Under the Health Care Authority, Washington State contracts with Universal Language Service to provide LAPs. Providers working with non-Apple Health/Medicaid patients can still access LAPs through this system but will not be reimbursed by the state (Washington State Health Care Authority, n.d.).
Also known as auxiliary aids, any device, except for a hearing aid, that amplifies sound or improves communication through alerts, such as vibrating alarm clocks or lights that flash when the doorbell is rung. This includes closed-loop systems that work with hearing aids.
Also known as Augmentative and alternative communication devices. A laptop or tablet computer that helps individuals with speech difficulties to communicate.