Exceptional communication is essential when providing care to patients in the ED. This is especially true given that we don’t have a preexisting relationship with our patients. They have never seen us before, have little or no information about us, and didn’t choose us. They are typically anxious, uncomfortable, and would probably rather be somewhere else. Exceptional communication allows patients to gain trust in us, in our skills, and in our recommendations. Strong communication skills not only allow physician and non-physician staff to gather relevant information and share important findings, but also help improve healthcare outcomes, reduce misunderstandings, and minimize litigation. Below are 10 pearls, divided into 4 habits, to help you get the most out of the clinical encounter and improve your patient’s care experience.

Invest in the beginning:

1. Greet everyone warmly.

After washing your hands, introduce yourself to your patient and to everyone in the room. Greet them warmly and sincerely, using culturally-appropriate gestures. Smile. Show that you are happy to meet them, and pleased to offer your skills and services.

2. Connect.

I recommend connecting or attempting to connect with everyone in the room. Show interest in them as people. Your patient is not just a chief complaint, a symptom or constellation of symptoms, or a presentation of an illness. He or she is likely to be a significant other, parent, child, grandparent, with interests, job(s), and dreams just like us.

3. Sit down if you can.

Do your best to make sure that everyone in the room is comfortable, including you. Sitting down is as important for you as it is for your patient. Adjust your patient’s bed, offer chairs to those standing or a blanket to your patient, and adjust the room lights. Patients feel as if you spend more time with them simply by sitting down.1

4. Listen actively.

Active listening is extremely challenging and takes practice. We all need to learn information about our patient’s condition, yet it is infrequently offered in the manner we need. Do not interrupt your patient or family members if possible (at least initially). Interesting things can be learned simply by listening. Our patients deserve, want, and need to be heard.

5. Take your time.

Although emergency physicians generally care for multiple patients at once, it is important to make patients feel as if they are your only concern at that moment. Your patient deserves to feel that they are not being rushed despite how busy you are. Strategies for success include addressing your patient by their correctly-pronounced name. If time permits, ask how they would prefer to be referred to AND how to pronounce their name. Other strategies include making good eye contact, projecting your voice so your patient can hear you, warming your hands, and performing your examination slowly and gently.

Elicit their perspective:

6. Ask your patient and family members, if appropriate, for their perspective.

It is important to ask your patients what they think is going on, what concerns them most, what their expectations are, and what they are hoping to accomplish from their visit. Learn where and how they got their information by asking. Don’t scold them for reading something on the internet. Having this knowledge helps reduce or prevent conflict, and provides you the opportunity to discuss or address any appropriate or unrealistic expectations they might have.

Demonstrate empathy:

7. Use at least one empathic statement.

In response to your patient’s descriptions of pain, suffering, stress, or concern, use one or more empathic statement [Permanente Journal 2003]. Make this genuine and sincere. It should be short, direct, and targeted. Make sure you allow space to let your empathic statement “land,” so your patient can absorb what you just said. Look for other opportunities to express empathy. Using appropriate body language or other nonverbal communication can further help demonstrate empathy and caring. Although you need the “facts,” often your patient’s pain, discomfort, anxiety, stress, or concern (and having it acknowledged) means more to her or him than a “final diagnosis.”

Invest in the end:

8. Check in with your patient.

Visit or check in with your patient often during their ED visit (see them at least twice — my rule-of-thumb minimum is once on arrival and once at discharge). Your patients will appreciate this, and will interpret this as additional caring and concern. Plus, it makes them feel as if you are spending more time with them (which is true). Work hard to offer your patient and family members frequent updates, provide test results, account for delays, and monitor their response to your treatment.

9. Close the communication loop.

Use the end of the visit to close the communication loop. This includes reviewing your action plan, discharge instructions, and follow-up recommendations or expectations. This also allows you to get a commitment from your patient to follow your instructions and to make sure that they are understood. If needed, this visit provides you the opportunity to attempt service recovery if things have not gone smoothly and your patient is not satisfied.

10. Show kindness and respect.

Kindness and respect towards your patient should occur throughout your entire interaction. Offer kindness and respect to everyone in the room, including family members, nurses, staff, and consultants. Your patient and support team will appreciate your positive attitude towards others. If they didn’t recognize your positive attitude towards them, this might help them recognize that you are a positive person. Whenever possible and appropriate, compliment your patient or others involved in your patient’s health.

Closing points

Notice how none of these pearls includes “prescribing narcotics” or “ordering unnecessary tests.” Exceptional communication skills and sincere caring include connecting, listening, empathizing, answering questions, checking in, and demonstrating respect at all times for all patients. These behaviors will help you and therefore your patient in nearly every situation. Although it may be challenging to recall these points and exhibit these behaviors with every patient, helpful mnemonics exist. One worth considering is A-I-D-E-T:

  • Acknowledge
  • Introduce
  • Duration
  • Explanation
  • Thank you

Finally, although presenting these habits and pearls sequentially might suggest a linear approach to communication and actions, it is best when your approach is fluid. These pearls are critical for success related to the moving target of patient satisfaction in emergency medicine. The patient care (or patient-driven) experience is the updated vision for service excellence in emergency medicine. Hopefully, these suggestions will improve communication, increase the likelihood that you connect with your patient, and enhance your patient’s experience in the emergency department.

Swayden K, Anderson K, Connelly L, Moran J, McMahon J, Arnold P. Effect of sitting vs. standing on perception of provider time at bedside: a pilot study. Patient Educ Couns. 2012;86(2):166-171. [PubMed]
Gus M. Garmel, MD, FACEP, FAAEM

Gus M. Garmel, MD, FACEP, FAAEM

Adjunct Professor of EM
Stanford University;
Inaugural Member/Distinguished Educator
CORD Academy for Scholarship in Education in EM