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ER Goddess

ER Goddess

The Right Delivery is All It Takes to Connect with Patients (and Not Get Sued)

Simons, Sandra Scott MD

doi: 10.1097/01.EEM.0000657684.03793.1b
    connection, malpractice

    The veteran pathologist at my little community hospital, who has been a fixture there more than twice as long as I've been out of residency, was kind enough to bring me some books he thought I'd enjoy in thanks for taking care of his friend. One of them was his hardcover copy of Blink by Malcolm Gladwell, which came with his wise assurance that I would relate to it. As it turns out, when a more experienced physician colleague recommends a book, it just may change your practice.

    The book is about thin-slicing, the art of distilling something to its essence in the blink of an eye. Sure enough, I could relate because it's what we EPs do every day when we look at patients and instantly differentiate between sick and not sick. It's not a medical book, but it draws one example from health care that resonated with me so much that I still find myself thinking of it months later when I'm at the bedside. It's a discussion worth sharing because it sheds light on the crux of our medical art.

    The memorable discussion in Blink looks at the way physicians talk to patients. It turns out that it is possible to thin-slice the way a doctor speaks to a patient and intuit how effective that doctor will be at establishing rapport. Even with just a brief exposure, our tone of voice and inflections convey volumes. In fact, after listening to just a short snippet of how a doctor talks to a patient, it's possible to predict that doctor's likelihood of being sued.

    Of all the touted benefits of good relationships with our patients, I would not say that avoiding lawsuits is the most noble pursuit. Avoiding lawsuits, however, is at least a measurable approximation of how successful we are in finding the golden chalice of patient favor. As they teach us in med school, you are less likely to get sued if your patients like you. A patient won't want to sue if he is fond of you, even if you screw up. Conversely, he'll find a reason to sue if he thinks you're a jerk, even if you were flawless clinically.

    A study by Wendy Levinson, MD, described in Blink had independent observers listen to 10-second clips of surgeons talking to patients and were able to discern which surgeons were more likely to have been named in a malpractice suit. (JAMA. 1997;277[7]:553.) Patients are making their own decisions about us in the same way we use clinical gestalt to make snap decisions about them, without our conscious minds even being aware of it. Doctors who sounded standoffish and authoritarian had a higher rate of lawsuits. The ones who cracked jokes and sounded more inclusive were sued the least. Think about that. Regardless of the clinical scenario, the doctor's experience, and other variables, all it takes is a snapshot of the doctor's delivery to reveal whether patients will like her enough not to sue.

    Under EPs' Control

    Here is the most remarkable part—the actual words themselves seem to make no difference as long as the tone is pleasing. Researchers in that same study blurred the enunciation so listeners could hear only the doctors' pitch, rhythm, and inflection, not what they said. It's possible to predict which doctors will be sued without even hearing the words. Apparently, there is truth to the old adage that it's not what you say but how you say it.

    This is an enlightenment both beautiful and empowering in its simplicity for all of us doctors in the trenches. The right delivery, one of openness and equality rather than condescension and distance, is all it takes. We spend a solid decade of our life learning the medicine and what to say, but we forget to think about how we say it, which, as this study shows, is what matters to the patient. As Maya Angelou said, people will forget what you said but remember how you made them feel.

    I find it comforting to know that my ability to connect with patients boils down to something within my control. I have no power over the corporatization of medicine, ED staffing, and the ever-increasing demands placed on EPs. I may not be able to stay as long as I want at the bedside or delve into problems as much as I want or even say what I want, but my tone of voice and delivery can always be the way I want. The same words in the same context can be received completely differently depending on the warmth and compassion of the interaction.

    I think about this every shift before I walk into a room, especially when it's a trying scenario. In 2020's medical climate where screens dehumanize medicine, my personality and my voice can still make all the difference. Doctors are not just interchangeable widgets delivering the same health care. Our unique experiences and personalities translate into patient connection.

    There are three morals to this story. The first is that when an older and wiser colleague recommends a book, it's worth reading. Learn from your older colleagues in the winters of their careers. The second is that you should read, for pleasure, something nonmedical. Pursuing your own interests will allow you to find hidden gems and tidbits of humanism for your ED arsenal. The third is that you have more power than you think in your voice and intonation. No matter how out of control your ED gets, you always have control over your delivery. The way we talk to each other matters more than we realize.

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    Dr. Simonsis a full-time night emergency physician in Richmond, VA, and a mother of two. Follow her on Twitter@ERGoddessMD, and read her past columns at

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