Communication is essential to practicing
medicine. It allows us to coordinate care
with other members of the healthcare team,
to ensure safe handovers, and to cultivate
trusting relationships with our patients. An
unassuming well-woman visit turned out to
be the one of the most profound illustrations
of its importance for me.
Mrs. X was a Spanish-speaking woman who
came to clinic for a well woman exam. I
called a hospital interpreter to help me take
a medical history. Besides an asymptomatic
fibroid and two C-sections, her history was
unremarkable. I reported this to the
attending, and we both went to the
patient’s room to discuss the seemingly
straightforward plan. Everything was going
smoothly, and just as we were about to say
goodbye, she asked,
“Doctor, do I have cancer?”
We paused. Why did the patient think she
had cancer? Did we miss something in her
“Several years ago a doctor told me I have
a mass in my uterus. It’s not causing me
pain, but I am very worried that it is cancer.
Do you think I have cancer?”
Then it dawned on us: the fibroid. The
asymptomatic fibroid, which was
completely benign, had been keeping this
patient up at night for years.
My attending grabbed a stool and sat
down. Pausing after every sentence for
translation, he maintained eye contact and
a warm demeanor while reassuring her that
asymptomatic fibroids were benign. As he
continued talking, the patient’s relief grew
palpable to everyone in the room. At the
end of the visit, the patient strode out with a
beaming smile on her face.
This is just one of many examples where
patience, understanding, time, and
awareness are essential to fostering an
environment in which patients feel
comfortable effacing their vulnerabilities,
asking questions to clear their doubts.
But the situation only begged further
questions for me: Why had this not been
addressed before? Had she tried voicing her
concern in the past and no one listened?
I see at least two perspectives.
Healthcare workers attend to large volumes
of patients, making it challenging to be both
efficient and thorough. Some days are just
busy: 25 patients on your service need to be
seen during morning rounds, and you have
a full day of clinic in the afternoon.
Balancing efficiency and thoroughness
seems impossible, and, at that point,
efficiency often becomes the priority while
thoroughness takes the backseat.
Patients, on the other hand, are coming to
you as individuals. They entrust you with their
lives and reveal their most sensitive
vulnerabilities. Add in barriers of unfamiliar
customs, a foreign language, and an
unstable financial source to an already
sensitive situation – coming to the doctor is a
I do not think either side is to blame. The
healthcare staff does their best to balance
the high volume of patients and their own
continuing education; patients naturally feel
more at home around caregivers who
speak their language and have a similar
So how can we as healthcare workers
improve this seemingly stagnant situation?
Improving larger forces at play (i.e. hospital
systems, access to interpreters,
reimbursement, administrative costs),
optimizing our verbal communication skills,
and educating ourselves about different
cultures and ways of life are important and
But there are also the subtleties.
Given the diverse populations we as
physicians serve, learning how to create a
comfortable space conducive to open
communication for all in spite of language
and cultural barriers is extremely relevant.
The Mehrabian communication model
illustrates that there are three aspects to
communication: verbal, non-verbal (i.e.
tone, intonation, volume), and visual (i.e.
body language). Only 7% of what we
communicate is conveyed by our literal
words, whereas 38% is conveyed by nonverbal
communication, and 55% by visual
communication . Therefore, the manner
with which we speak and the way we carry
ourselves hold far more weight than the
Maybe we don’t have time to extensively
educate patients during that hectic
morning before rounds, but we can pause
for two seconds to look them in the eye and
smile, or put a hand on their shoulder when
asking how they did overnight. These small
acts can garner trust so that, perhaps, when
you or another physician down the road do
have time to teach, they will be in a less
anxious headspace to process that
information and understand. Patient
education is important; I would argue
creating a safe space in which patients feel
empowered to change is equally important.
Great potential to improve relationships lies
in the subtleties: being mindful of our body
language, purposeful with our gestures.
Unless we are vigilant, these seemingly
insignificant actions and reactions
contribute to a strained physician-patient
Circumstances may prevent us from
delivering optimal care despite our deep
desire to do so, which can be the most
frustrating. It is important to not let our
frustration of the system affect the quality of
care we give to our patients in that
We may not always speak the same
language and understand their struggles,
but all humans know love, no matter the
culture, no matter the language. It’s hard to
determine what exactly prompted Mrs. X to
open up, but I can’t help but believe that it
was due in part to the environment that her
previous caregivers and we created. If we
make a conscious effort to express this
compassion and love each day, it will be a
step forward in addressing barriers to care,
giving patients a voice, and making them
feel at home.
1. Mulder, P. (2012). Communication Model by Albert Mehrabian.