Communication, as they say, is a two-way street. For several years, we have taught medical students the art of communication. They learn to develop rapport with patients through eye contact, body language that conveys interest in what the patient is saying, and by demonstrating an interest in the patient as a person . They learn to signpost their
way through the encounter to let the patient know what to expect next, reducing the patient’s anxiety. They learn to deliver “bad news” with the SPIKES protocol. Strategies to help patients remember what we tell them are taught and practiced. Although doctors are often criticized for their communication style, our profession is working to improve our skill set. That’s one side of the communication street.
But what are we doing to enhance our patients’ ability to communicate with us?
Many times, patients leave our offices more confused than when they came, their real questions unanswered, even though we offered our best care. In order to change this, it’s time for us to assist our partners in communication – our patients. Karen Knops MD, an experienced palliative care specialist in Washington, along with the Gold Foundation, dedicated to Keeping Healthcare Human, provide us with an excellent tool for this purpose. ASCEND is a simple mnemonic that provides six principles and practices to assist patients in becoming strong and effective partners in their care.
Dr. Knops suggests that patients develop the habit of Anticipating their doctors’ appointments by thinking about the purpose of the visit and considering what questions they want to be answered and who should accompany them. After her experience as a teenager with scoliosis, she shares that, “I’ve never lost my awareness that commonsense can easily go on hiatus when we are gowned and vulnerable. Taking notes should have occurred to me as a straight-A student, but never once did I try that. I would log hours practicing for a youth symphony audition, but preparing for a doctor visit never crossed my mind.” Once in the room, patients can ask their physician for a Summary of the big picture before details are discussed. They can share their Concerns, Explore the risks and benefits of planned tests or treatments and ask for Explanations, including what the Next steps will be. And they should be sure to Document the important information and instructions.
We provide patients with all sorts of assistance – why not suggest a simple mnemonic that will help to ensure the smooth flow of communication in both directions?