Negotiating and Communicating With Patients

Gone are the days when patients unquestioningly heeded a physician's advice. Today, Internet-connected patients come to the doctor's office armed with information and questions, and treatment can turn into a negotiation.

The idea of negotiating with a patient may seem odd, or even off-putting, to physicians and patients alike.

But many physicians find they’re using management and leadership skills – such as negotiation and communication techniques – directly with patients, according to Kasisomayajula “Vish” Viswanath, professor of health communication at Harvard T.H. Chan School of Public Health’s Department of Social and Behavioral Sciences.

Gone are the days of the “paternalistic” relationship between doctor and patient, where “the physician is god” and “whatever he says is true,” said Viswanath. Today, physicians share decision-making with their patients, because patients must navigate careers, families, time constraints and other realities, and they need to work with physicians to establish effective, individualized treatments.

Negotiating with a patient may seem odd, or even off-putting, to physicians and patients alike.

It’s a “consumerist model” with “shared decision making,” Viswanath said, and he noted physicians are hungry for techniques on how to communicate with patients so they leave with satisfaction and a commitment to comply with treatment.

What’s more, technology, particularly the Internet, has made patients “much more aware” of medical issues, according to Barry C. Dorn, adjunct lecturer in health policy and management at Harvard Chan School. As a result, treatment often becomes “a negotiation between you and the doctor,” he said.

Viswanath agreed. “Patients are coming to physicians much more prepared than they have in the past,” he said.

Viswanath, who also serves as director of the Health Communication Core at Dana-Farber/Harvard Cancer Center, said cancer treatment, especially, is an area where this dynamic plays out. When a patient runs out of options and hears about a new drug, “it’s very reasonable” to ask a physician about it, he said. It’s an instance when effective communication is key, because patients often don’t realize such drugs are still experimental.

“Physician colleagues of mine routinely receive calls” about new drugs, Viswanath said.

Or, when patients hear in the media about public health issues – Ebola, for instance – they “call the physician’s office immediately,” he added. Managing those communications and broadcasting an accurate message that doesn’t panic patients can be “a delicate balance.”

Patients come into the office with lots of information and misinformation, and as a physician, “you have to understand the communication environment,” Viswanath said. It seems that, on top of everything else, today’s physicians need public relations and communications savvy.

Treatment often becomes “a negotiation between you and the doctor.”

It helps with the job, Viswanath said, because around the world, physicians are considered some of the most credible people in society. That means their words carry weight.

He gave an example: When it comes to important health issues, such as getting people to quit smoking, studies have shown that big public awareness campaigns are good at prevention, but doctors, communicating and negotiating face-to-face with patients, are more effective at getting individuals to actually quit.



Harvard T.H. Chan School of Public Health offers Applied Risk Communication for the 21st Century , an online program designed  for evaluating risk communication efforts