Assertive communication: Important for safe patient care

Posted on May 27, 2013

The differential between the perceived power of the doctor and the patient intimidates many people, making them feel helpless, subservient, and unwilling to question the doctor, ask for what they need or be completely truthful. Patients often fear that there will be retaliation from doctors if they don’t agree with, or question the doctors’ recommendations.

It’s important to understand that competent, compassionate physicians want their patients to be honest with them and to ask questions when they are unclear about medical information or treatment options. Physicians want their patients to be well informed, since knowledgeable patients are more likely to follow through on important medical instructions and treatment regimes.

In today’s health care system, with the overload of information, increased administrative burden on physicians and limited time with patients- you, as the patient must be an active participant in your own care.   Research supports that patients who participate in their care have better health outcomes.

Being assertive is an important communication skill to master to facilitate clear communication with your health care providers and to help ensure that you receive safe, quality care.  Making your symptoms, concerns and care goals known, clearly, concisely and respectfully, to your medical providers is very important. This information is critical for you to receive an accurate diagnosis and personalized treatment plan consistent with your values and needs.

Here is some information about assertive communication techniques that may be useful.

Assertiveness is defined as a form of communication in which needs or wishes are stated clearly with respect for oneself and the other person in the interaction. Assertive communication is distinguished from passive communication (in which needs or wishes go unstated) and aggressive communication (in which needs or wishes are stated in a hostile or demanding manner).

When you act assertively you act fairly and with empathy. The power you use comes from your self-assurance and the valuing of yourself and your rights.

Assertive Communication Techniques

There are a variety of ways to communicate assertively. By understanding how to be assertive, you can adapt these techniques to any situation you are facing.

I statements

Use “I want.” “I need.” or “I feel.” to convey basic assertions.

I need to have my questions answered before I can make a decision about treatment.

 Empathic Assertion

First, recognize how the other person views the situation:

I understand that you are having trouble meeting my request for more medical information.

Then, express what you need:

...however, this issue is causing me unnecessary distress and needs to be resolved. Let’s discuss some options. Perhaps my appointment can be extended, or I can schedule a follow-up appointment so we can have more time to discuss my questions.

Escalating Assertion

This type of assertiveness is necessary when your first attempts are not successful in getting your needs met.

The technique involves becoming more and more firm as time goes on. It may end in you telling the person what you will do next if you do not receive satisfaction.

Mary, this is the third time this week I’ve had to call to get my lab results because there was no follow through on my voicemail messages. If the communication problem continues this week, I will bring the issue to Dr. Smith’s attention.

 Broken Record

Prepare ahead of time the message you want to convey:

I must have my lab results within 24 hours of the blood draw in order to safely plan my daily activities.

During the conversation, keep restating your message using the same language over and over again. Don’t relent. Eventually the person is likely to realize that you really mean what you are saying.

I have many other patients and can’t get back to you that quickly.

I must have my lab results within 24 hours of the blood draw in order to safely plan my daily activities.

That is impossible to promise every week.

I must have my lab results within 24 hours of the blood draw.

Well, I will have to speak with the doctor about your request.

I appreciate you bringing this request to her attention since I must have my lab results within 24 hours of the blood draw.

Ask For More Time

Sometimes, you just need to put off saying anything. You might be too emotional or you might really not know what you want. Be honest and tell the doctor that you need time to process the information.

Dr. Jones, your recommendation that I have more surgery has caught me off guard. I’ll get back to you next week after I have had time to think more about it.

Scripting

This technique involves preparing and rehearsing your responses using a four-pronged approach that describes:

  1. The event: tell the other person exactly how you see the situation or problem. 
Mary, I need the results of my lab work to know my vulnerability to infection and plan my daily activities safely. When I receive my lab results one week later after promises that the results will be sent earlier, I am completely baffled by the lack of follow up.
  2. Your feelings: tell the other person how you feel about the situation and express your emotions clearly. 
This frustrates me and makes me feel like you don’t understand or appreciate how important this information is to me as a patient.
  3. Your needs: tell the other person what you need so they don’t have to guess. 
I want you to hear me and help me to get my lab results in a more efficient manner. 
  4. The consequences: describe the positive outcome if your needs are fulfilled. 
If we can discuss solutions that can work for both of us, then together we can turn this problem around and save time and effort.

Once you are clear about what you want to say and express, it is much easier to actually do it.

 

 References

Mind Tools Corporate (www.mindtools.com)

Dr. Carolyn Oliver, Cautious Care: A guide for patients.

About.com (www.About.com). Assertive Communication