7 Tips for Communicating with Patients as a PA
As a physician assistant, the ability to effectively communicate with patients is not just a desirable skill—it is an indispensable art that lies at the heart of providing quality healthcare. Beyond the mastery of medical knowledge and technical expertise, the art of communication sets the stage for building trust, fostering collaboration, and ultimately delivering exceptional patient care.
In the fast-paced and ever-evolving world of healthcare, the significance of effective communication cannot be overstated. It serves as the cornerstone for establishing strong patient-practitioner relationships, promoting patient understanding, and ensuring successful treatment outcomes. In this blog post, you’ll find my top seven tips for communicating with patients as a dermatology PA, which can apply to PAs working in any other specialty.
1. Anxious Patients Need Space and Accommodation
Meeting with a healthcare practitioner can be a stressful, anxiety-provoking experience for some patients. Upon entering the examination room, I try to get a sense of how tense a patient is. If they are wrapped up in the gown, holding their hands under their arms, sitting with their legs crossed, and not making eye contact, I prefer to give them some distance initially. I stand near the entrance to the room, sanitize my hands in view of the patient, and ask them an open-ended question, such as, “How may I help you today?”
If the patient begins describing the problem, I allow them time to complete speaking without interruption. If the patient requires a procedure, I always let them know if we may observe the problem instead, and I ask about the patient’s preference prior to beginning anything. I have had new patients let me know they need to be fully supine to feel comfortable, they prefer topical numbing even though it requires extra time, or they prefer I wear gloves to perform my exam.
What This Looks Like in Practice…
For example, let’s consider a recent situation where a new patient came to see me for a full-body skin exam. They were concerned about a mole on their abdomen that was present for many years and appeared to be growing. To put them at ease, I let them know that it looked like a benign growth that could be observed or removed. Since the patient noticed it was growing, they preferred a biopsy for pathology.
While I was describing the procedure and aftercare, the patient stated they were extremely afraid of needles and could not complete the biopsy with a local anesthetic. I looked for a way to ease their anxiety. I let the patient know we have topical numbing and a local cold spray I could use, but it would require extra time. The patient agreed, we applied topical anesthetic for 10 minutes, and I had my medical assistant spray the site with cold spray while I performed the biopsy. My assistant provided the patient with a cup of water post-procedure.
In the end, things went well, but it could easily have turned out otherwise. By listening to the patient and doing what I could to ease their anxiety, we were able to successfully complete the biopsy in a way that made the procedure go as smoothly as possible. This increased patient satisfaction and set the stage for positive interactions in the future.
2. Focus on Their Top Priority
Having too much to discuss with a patient can result in poor communication. If they arrive with multiple problems to address in a single appointment, I ask them to tell me their chief concern. Once the patient classifies what is most important to them, I am able to focus on that problem, and together we can address additional concerns at the follow-up.
What This Looks Like in Practice…
For example, I recently had a new patient schedule an appointment to examine a skin growth on their back. When they arrived, they also wanted to get their yearly skin check done. I decided to get started on the growth first, and address the skin check later. The patient was polite, described a non-inflamed cyst on the back, and asked for possible options.
I discussed observation versus treatment with excision. The patient noted the lesion was asymptomatic, and therefore, they preferred to observe the site for now. After providing the patient with aftercare information about cysts, I suggested we schedule the yearly skin check in a few months. I provided my business card should the cyst need immediate attention, asked if the patient had any additional questions, and thanked them for the visit. The patient thanked me for being so informative and offering a skin check in the future.
3. If Necessary, Have Them Make a List of Priorities
In some instances, regardless of how diplomatically I try to communicate that appointments are intended to address one chief concern, the patient insists that they paid for a visit and want all issues addressed during the visit. In this instance, I will have the patient list all of their concerns on a sheet of paper.
Depending on preference, I will offer to address the top three concerns that day and save the list for a follow-up appointment in 4 weeks. The goal is always to provide the best possible care in the allotted time, and as such, it is requisite to remember other patients have scheduled appointments, too.
What This Looks Like in Practice…
One of these instances occurred a few weeks ago. The new patient arrived twenty minutes late and had concerns including a full body skin exam, rash on the back, and discoloration on the face. I introduced myself, asked how I may help, and the patient stated the chief concerns. I concluded my exam and treatment recommendations, then provided aftercare sheets with prescription instructions.
I was asking the patient if they had questions when the patient stated, “What about my hair loss?”
I replied, “Hair loss is a complicated diagnosis that requires a separate exam, diagnostics, and treatment plan.”
The patient stated, “Well I am here now, do I have hair loss?”
I again offered to address the concern at the follow-up appointment. When the patient protested waiting until the follow-up appointment, I asked where the patient was noticing hair loss and if it were symptomatic.
The patient stated, “I don’t have symptoms. I just want to know if I have hair loss.” I provided my hair loss aftercare sheet and provided general hair loss treatment options. Again, I emphasized that a tailored treatment plan would be the better option at a follow-up appointment dedicated to exploring all causes of hair loss. The patient took the aftercare sheet and did not return for the scheduled follow-up appointment.
4. Engage in Discussions With Active Patients
The active patient encounter involves someone who is eager to present the history of their present and past illnesses. In addition to being thorough with their medical history, this patient is actively involved in decisions, including those regarding medications and procedures. Encounters with active patients can be enjoyable when the patient is willing to listen and contribute to the discussion.
What This Looks Like in Practice…
As an example, a patient presented with a diagnosis of psoriasis in sensitive areas of skin folds, including the underarms, groin, and buttocks. They were open to a thorough exam and biopsy for confirmation. Biopsy results at a follow-up appointment showed inverse psoriasis. I offered the patient treatments including topical steroids, intralesional steroid injections, light therapy, and biologics.
Through discussion, I learned the patient did not want to use topicals as they were too difficult to apply daily, and oral medications that may cause GI symptoms were also not desirable. As a result, the patient and I decided to start an injectable biologic, which would be dosed every few weeks.
As noted, it can be enjoyable to work with active patients. When they contribute to the discussion, the diagnosis and treatment plan evolve organically. Allowing them to communicate ideas about their treatment makes your life easier and improves their overall experience.
5. Make it a Point to Build Trust with Patients and Caregivers
Patient encounters that involve family members can be challenging. For example, children and adolescents are often not accurate historians of their chief concern. This requires you to speak with a parent or guardian to make sure you are gathering accurate information.
Similarly, patients with senior relatives may need assistance creating a workable treatment plan for those patients in assisted living facilities. It’s very important you work with both the child and the parent or guardian when you attempt to develop a treatment plan. Once the patient and caregiver trust that you will support and create treatment options that align with their preferences, these visits can be positive encounters.
What This Looks Like in Practice…
For example, I had a pediatric patient who presented with “acne on the body.” I was skeptical that a six-year-old had acne, so I sought additional information from the mother. After speaking with her and giving the child a physical exam, I let the mother and patient know the bumps were not acne but molluscum contagiosum, a virus that leaves umbilicated pink bumps from skin-to-skin contact. Then I let the patient and mother see one of the bumps through my dermatoscope.
By speaking with the patient and the mother, and involving them in the diagnostic process, I was able to build trust and set the stage for a successful treatment plan. We discussed options including observation, topicals, or extraction. The patient and mother preferred to start over-the-counter options at home and follow up in one month. Even though the mother was unhappy to learn the patient had molluscum contagiosum, she was relieved to learn there were treatments available and we could prevent it from spreading.
6. Suggestions Can Open Doors
New patients sometimes have well-established diagnoses with effective treatment regimens. Even if the treatment regimen is not my preferred routine or topical, I try to solicit patient information as to why or how they feel the regimen is efficacious. I then offer to provide a new prescription with enough refills for the year. Simultaneously, I offer to complete the patient’s full-body skin exam and stress the importance of sun protection. As a result, many of them become established patients and thank me for offering to perform their skin checks.
What This Looks Like in Practice…
As an example, a new patient visited to get refills of her acne medications. She was well-controlled with her oral and topicals, and she wanted to establish care to have the prescriptions available for the year. I suggested a full-body skin exam to check for moles and any other concerns. As we were talking, the patient offered that she did have a history of indoor tanning as a teenager and had never had a skin exam before. The patient scheduled a follow-up skin exam in one month and thanked me for suggesting the appointment.
7. Help Coordinate Complicated Cases
Patients with complicated diagnoses involve more referrals and coordination at visits. I often send for imaging, call primary care providers to request referrals, or call other specialists to coordinate treatment plans. Diagnoses such as those involving rheumatology, orthopedics, vascular consultations, or follow-up with primary care providers necessitate attention to detail during the visit to document other offices, providers the patient sees, and when they are next scheduled for follow-up.
I will make it a point to tell the patient I am going to call their primary care doctor or specialist to ensure plans are being clearly communicated. This demonstrates to the patient your interest in their treatment plan.
What This Looks Like in Practice…
As an example, I diagnosed a patient with dermatitis herpetiformis, the skin rash caused by celiac disease. The patient had eczema on her elbows, backside, and neck for years. Suspecting a different etiology, I performed two biopsies. One biopsy was to check the cause of the skin rash, the second biopsy was to check for the circulating IgA antibodies that cause the skin manifestations from gluten sensitivity. After starting medication for the rash and removing gluten from her diet, the patient admitted she felt better, the rash resolved, and she had lost weight.
At her follow-up visit, I asked the patient if she had seen her gastroenterologist. The patient stated she did not see a reason to follow up with them since her rash resolved. I let the patient know why she needed to establish care with the gastroenterologist and my intentions to call her primary care doctor to disclose our conversation and plan. The patient thanked me for helping her and noted she would schedule her gastroenterology visit.
Further Reading
Navigating patient encounters takes time and practice, and in many ways, it comes down to the art of communication. Use the seven tips we discussed in this article and you will become a better medical practitioner!
If you are interested in more (free!) PA knowledge, check out these other posts from the Rosh Review blog:
- How to Recognize and Manage Burnout as a PA
- Introducing the First Qbank for Lifelong PA Learners
- ECG Tips for Physician Assistants: A Tutor’s Guide
- How to Negotiate Your Contract as a Physician Assistant
- So, You Want to Change PA Specialties… Here’s What to Do Next
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