We know both anecdotally as well as through research that the strength of a patient-HCP relationship is a critical factor for successful treatment and adherence. On an intuitive level this makes sense; most people can identify the benefit of strong interpersonal relationships in their own lives. In healthcare, an individual is more likely to trust and follow the recommendations of an HCP with whom they perceive they have a good relationship. How can pharma cultivate strong relationships between people and their HCPs? Health psychology gives us a framework to create tools to enhance dialogue and foster strong, collaborative relationships.
Benefits of Effective Communication
Patients who feel that they have a good relationship with their HCP are more likely to be open and honest in their responses. HCPs are likely to gather better quality and quantity of information if the relationship is strong. Further, it allows the clinician to set and temper expectations about diagnosis and treatment. This alignment is critical for patient satisfaction and important for driving treatment persistence over the long term.
Yet a challenge remains. The average patient-HCP interaction lasts, on average and across specialties, 13 to 16 minutes. Given the reality of time limits, both the HCP and the patient must wisely use appointments. This dialogue can’t simply be small talk or address a pressing issue; it must also strengthen the relationship in general. Both parties must engage in the dialogue—taking turns asking and answering questions. The HCP may be the expert on health and illness, but the patient is the expert on his or her self.
It Takes Two to Communicate
It may seem an insurmountable task to accomplish in 13 minutes: Assess an immediate ailment; follow up on a chronic condition; establish or amend treatment/disease management; educate; answer questions; build rapport and learn enough about the individual to simultaneously be able to determine any barriers (practical, emotional, or cognitive) to education or treatment adherence. Whatever conversation occurs must be multipurpose: Address issues, educate, and building a relationship.
Most patients recognize the limited amount of face-to-face time they have with an HCP, but they still want to feel they have been heard, treated well, and have a positive experience during an office visit. Giving patients vague directions such as suggesting they write down questions and concerns, bring medications, or “be ready” for an appointment, not only seems dismissive, but also does little in helping patients prepare for broader conversations about their thoughts, beliefs, and learning styles. We do a tremendous disservice to patients by not better preparing them. There is enormous opportunity to equip patients with the skills to have to begin these conversations and teach them—and about the importance of having them.
Communication: More Than a Two-way Street
The million-dollar question then, is what tools are available to add in the creation of a quality relationship. A variety of communication strategies can be critical in the exchange of information. These include:
- Asking open-ended questions
- Practicing active and reflective listening
- Engaging the person with whom you are communicating
However, it is also important to recognize communication strategies alone do not build an interpersonal relationship. That requires a partnership, with responsibility placed equally on the HCP and the patient. The HCP brings the medical training and expertise. A patient brings the practical experience of what it means to live with a disease every day. While the perspectives are different, they are equally valuable and should lend equal weight to determining treatment management.
Health Psychology Drives Effective Conversations
In recent years, tools such as motivational interviewing and patient interviewing have become trendy catch phrases for understanding and engaging patients. While these are certainly steps in the right direction, they require training to use properly. Rather than rely on one or two formal techniques, it is often more realistic and effective to leverage principles of health psychology that can be adapted in many ways to fit many different dialogues.
Health psychology seeks to understand the whole person—the physiological, psychological, emotional, and even social aspects of a person’s life. It helps us to better understand the areas of an individual’s life that may need to be addressed. If we combine these content areas with good communication skills, HCPs can ask questions in open and explorative ways that allow the patient to add breadth and depth to their answers. Then, by asking a few seemingly simple questions about beliefs, barriers, and motivators, HCPs can ascertain a better general understanding of the individual and also know what concrete factors need to be addressed in a conversation in order to promote treatment adherence.
We know from the principles of health psychology that social support is important for self-management of a disease and for treatment adherence. So, if an HCP begins by asking a patient—using a simple Likert-type scale of 1 to 5—how supported they are by family and friends, it can actually lead to a treasure trove of information. If an individual answers that they are a “2,” meaning they don’t have much social support, an HCP may follow up with an open-ended question (“Can you tell me about what kind of support you think would be helpful?) to reveal additional details and begin a dialogue. Simple supportive statements, acknowledging that some people find asking for help difficult, or brainstorming the type of support that is needed and who could provide it, are beginnings to more in-depth discussions. If patients indicate they do have the support of family and friends, a complex diagnosis or treatment regime may be lightened by including another person in the conversation.
The quality of interpersonal relationships is a result of the strength of the effort put forth by both the patient and the HCP. By utilizing a few skills borrowed from health psychology, the HCP can become a more integral part in supporting the patient to self-manage. In turn, the patient can gain self-assurance around managing and taking charge of their own health, illness, and well-being.