Providing Healthcare in a Public Health Emergency Part 7: Avoiding Missteps and Professional Consequences Related to Communication with Patients

Part 7: Communication with Patients

Welcome to part seven of our ongoing blog series exploring how health care providers (HCPs) can avoid missteps and professional or legal consequences in the face of shifting professional responsibilities and challenging work environments caused by the COVID-19 pandemic. In this installment, we will discuss communication with patients during a public health emergency.

Communication with Patients

Good communication is a cornerstone of professionalism for HCPs. Not only is it important for obtaining informed consent to treatment and fostering trust in a therapeutic relationship, it also contributes to better patient outcomes and can help prevent complaints. Unfortunately, there are several aspects of the COVID-19 pandemic that has complicated or interrupted the therapeutic relationships between HCPs and their patients, from restrictions on in-person and non-essential treatment, implementing social-distancing and other safety precautions, to resource allocation decisions.

Even as in-person and non-essential services gradually resume in Ontario, it is still not “business as usual” and will not be for quite some time. Good communication with patients can go a long way to alleviating patient concerns about their health, delayed care and how to navigate the health care system during COVID-19. Conversely, poor communication can contribute to a patient’s anxiety or confusion and may even lead to a complaint.

Communication issues are already known to be a leading cause of complaints for physicians. In 2018, The Canadian Medical Protective Association (“CMPA”) reported that communication between physicians and patients was a root of patient complaints to the College of Physicians and Surgeons of Ontario (“CPSO”). A Canadian study from 2007 identified a similar pattern and found that the scores achieved in patient-physician communication and clinical decision making as evaluated by the Medical Council of Canada clinical skills examination communication score predicted future complaints to medical regulatory authorities. Examples of behaviour that would lead to a low score included condescending, offensive, or judgmental behaviors, or ignoring patient responses during the practical examination.

The following is a list of tips for HCPs to improve their communication with patients compiled from the CMPA, CPSO and CNO that can help HCPs do a check-up on their own communication skills:

• Observe etiquette and treat your patients with respect (i.e. knock before entering a room, introduce yourself and tell the patient what your role is, make eye contact, do not rush etc.);

• Practice active listening and summarize or paraphrase what a patient has told you;

• Focus on your patient and minimize the use of cell phones and other devices;

• Be alert to non-verbal cues, including your own – in the context of PPE which obscures the face or distorts voices, consider what non-verbal cues are not being communicated but should be and verbalize them;

• Use open ended questions at the beginning of your encounter;

• Seek information regarding the patient’s goals, preferences, values etc. that may be relevant to patient care;

• Share decision making and make your patient a partner in their care;

• Express empathy and acknowledge emotions;

• Avoid judgemental or discriminatory language;

• Maintain professional boundaries and do not make personal comments or self-disclose personal beliefs;

• Provide information in clear and simple terms and avoid medical jargon or abbreviations;

• Be aware of how differences such as gender or cultural background may affect communication styles;

• Undertake training in de-escalation techniques and avoid reactions that are defensive or otherwise discourage patients from voicing concerns; and

• Document patient encounters using professional language.

In addition to these all-purpose tips, HCPs should take care to explain any COVID-19 related issues that may have an impact on patient care and anticipate that patient interactions may take a little longer than usual. For example, it is recommended that HCPs inform patients of any changes in procedure or expectations due to COVID-19 ahead of their appointment for both in person and virtual visits to help manage expectations.

By following the above recommendations, HCPs lower their likelihood of attracting professional consequences or legal liability due to communication mistakes and can help mitigate the effects of the COVID-19 pandemic on their patients. It is important that HCPs continue to evaluate their communications skills in light of the shifting professional standards and challenging work environments presented by the COVID-19 pandemic by monitoring health directives, emergency orders, and other policies that affect how HCPs deliver health services during the current public health emergency.

If you or your organization have questions regarding how to implement public health directives and other COVID-19 related policy changes, please contact us.

Additional resources for HCPs:

• Ministry of Health and Long-Term Care “COVID-19: Guidance for the Health Sector”

• College of Physicians and Surgeons “Covid-19: Information for Physicians”

• College of Nurses of Ontario “Covid-19: Information for nurses”

• Ontario College of Pharmacists “Novel Coronavirus (COVID-19) for Pharmacy Professionals”