Duke physician Neil S. Prose, MD, says that most doctors are “explainaholics -- we like to offer information without taking the time to listen and to express understanding for the way that our patients are feeling.”

Since 2008, Prose has been leading seminars, workshops, and conferences to train residents and fellows in the art of empathic communication. More than 300 residents and fellows in pediatrics, medicine, obstetrics–gynecology, and surgery have participated in the program, which is funded by a Graduate Medical Education Innovation Grant.

“Half of our work as doctors,” says Prose, “is building relationships with patients and their families. But very little of our graduate education curriculum is devoted to doctor-patient communication. The good news is that we all want to communicate well, and the specific skills that work in the most difficult situations are teachable and learnable.”

The seminars help participants develop techniques for dealing with situations in which communication can be difficult, such as interacting with angry or disappointed patients or delivering bad news.

Prose covers everything from body language -- making eye contact and the importance of sitting instead of standing -- to asking open-ended questions (“How are you feeling today?”), to reflective listening -- saying back to the patient what you believe you have heard them say.

Other important techniques include naming the emotion the patient is probably feeling and explaining that those feelings are normal (“I can see that you’re worried, and I can imagine why you’re feeling that way,”) and asking permission before explaining what’s gone wrong or giving advice.

Prose also suggests ending every medical visit with a simple question -- “Is there anything else you want to tell me?” -- and then waiting to hear the answer.

The seminars also include role playing with actors as patients, so that residents and fellows have the opportunity to “try on” the words and phrases that they may not be accustomed to saying, and to experience the results.

“As physicians, we have an obligation to listen to a patient’s story -- the whole story -- and empathize as much as we can. Our patients need to know that their feelings are understandable,” says Prose. “The guiding principle behind the course is doing the right thing for our patients.”

Seven Phrases for Difficult Discussions

Prose recommends using one of these phrases when difficult situations arise with patients.

“It sounds like you’ve been through a lot”

“Please talk to me about it”

“Let me see if I have this right”

"I understand why you might be worried or frustrated”

"Is there anything else you would like to tell me?”

“Would it be okay if I try to explain what happened, what I think went wrong?”

“Here’s what I think we can do to keep it from happening again”

Innovation Grants

Duke residency program directors are full of great ideas on how to improve patient care and physician training -- or health care overall. But the resources needed to make those ideas a reality can be hard to come by.

Neil Prose’s program is one of many small-budget projects that have been funded by an Innovation Grant from the health system’s Office of Graduate Medical Education.

The GME Innovation Program, which began in 2008, was created by Victor J. Dzau, MD, chancellor for health affairs and president and CEO of Duke university Health System, with the specific goal of making small investments that can have a big impact on residency training by impacting patient care, curricula, or clinical research.

“Most of these grants are small,” says Kathryn Andolsek, MD, associate director of graduate medical education, “but they’re supposed to be -- and it’s the kinds of funding that these physicians wouldn’t be able to get any other way.

“Thanks to Dr. Dzau’s commitment, we’ve been able to maintain this program even in tough economic times,” says Andolsek. “We’re grateful to be able to keep such a strong focus on enhancing education.”

In the spirit of “a little goes a long way,” Andolsek reports that the average funding is $79,000, but some projects receive as little as $3,600 -- and the impact of those projects is worth far more.