Are Your Clinicians and Nurses Communicating Compassionately With Patients?

Healthcare organizations can teach clinicians and nurses compassionate communication skills, including deep listening, clarity, and understanding patients' perspectives.

Compassionate communication is essential to establish trust between clinicians and their patients. Trust is foundational in creating meaningful connections and working relationships with patients.

A fellowship program at UC San Diego Health is teaching clinicians and nurses about the intricacies of compassionate communication with patients.

"What we teach is all about the communication and connection between clinicians and patients," says Evonne Kaplan-Liss, MD, MPH, director of the Center for Compassionate Communication at the UC San Diego Sanford Institute for Empathy and Compassion. "An emotional connection between a clinician and a patient is established in the first two minutes of a clinical encounter."

There are several essential elements in compassionate communication, according to Kaplan-Liss.

"In compassionate communication, the receiver feels heard, taken care of, and understood," Kaplan-Liss says. "The skills required for compassionate communication are deep listening, clarity, understanding the receiver's perspective, and authenticity."

Evonne Kaplan-Liss, MD, MPH, is director of the Center for Compassionate Communication at the UC San Diego Sanford Institute for Empathy and Compassion.

How the fellowship program works

The UC San Diego Health Sanford Compassionate Communication Academy Fellowship program uses exercises grounded in the arts and humanities along with role playing to teach clinicians and nurses the skills necessary to communicate compassionately.

"We use journalism skills, improvisation skills, visual arts, and narrative medicine exercises to help clinicians connect with patients and communicate with compassion," Kaplan-Liss says. "As a patient myself with chronic conditions, I have seen firsthand how ineffective communication impacted my health. I have been on the receiving end of bad communication."

Journalism skills are helpful for clinicians to communicate compassionately and effectively with patients. The use of jargon is a huge problem for healthcare providers and patients, according to Kaplan-Liss.

"In journalism, people are trained to avoid the use of jargon and to connect with audiences at a sixth-grade level," Kaplan-Liss says. "So, we focus a lot on avoiding the use of jargon and distilling messages to patients. We want clinicians to put the most important information first when they are talking to patients, which is like a journalist focusing on the lead of a story."

To help clinicians gain an appreciation of patients' different perspectives, the fellowship program uses visual arts exercises.

"We have fellows view the same piece of artwork, and many of them see the artwork differently," Kaplan-Liss says. "There are elements of the artwork that people do not see or see differently. This is an important exercise because it encourages the fellows to slow down and helps them understand that something can be seen in many ways."

Role playing is a primary component of the fellowship program. Clinicians not only role play with other clinicians, but also with theater artists, and they receive feedback from the artistic lens of actors.

"The beauty of role playing is getting to practice outside of your normal environment as well as getting feedback from colleagues and artists," Kaplan-Liss says. "Clinicians can try communicating in ways that are different from the ways they are normally communicating with patients."

The feedback from role playing exercises gives clinicians insights into how they are communicating with patients.

For example, during one role playing exercise between a physician and an artist, the artist noticed during the exercise that the physician's body language and facial expressions were not matching what the physician was saying. The physician looked intense, and the news that was being conveyed came out more intense than it needed to be delivered.

"With in-the-moment feedback during a role-playing exercise, a clinician can gain insight about their facial expressions and eye contact," Kaplan-Liss says. "These are important bits of information that a clinician can learn from and practice."

Role playing also hones listening skills. Listening involves observation skills to make sure patients feel heard, Kaplan-Liss explains.

"Clinicians should not interrupt their patients," Kaplan-Liss says. "When a physician interrupts a patient, it diminishes trust and lessens the likelihood that a patient is going to answer questions that need to be addressed. Clinicians need to give patients time and space, and they need to avoid cutting off a patient."

The fellowship program teaches clinicians and nurses about the nonverbal elements of compassionate communication.

"We teach fellows about the importance of body language, eye contact, facial expressions, and where they should be physically in an exam room," Kaplan-Liss says. "We teach physicians, advanced practice providers, and nurses about where they should be in a room when there is a computer in the room that they must use. We teach fellows about where they should sit and the level where they are positioned when they communicate with patients."