Empathy and Engagement Are Key Elements of Successful Healthcare Communication

About a year or two ago, I saw a patient in clinic: a healthy 40-year-old woman with a BMI in the high 30s and a mostly sedentary lifestyle, partly due to her worsening knee pain. Her radiographs showed some joint space narrowing. A common scenario, no doubt, but a couple of things made her stand out. First, she had driven all the way across Oregon to see me for her early knee osteoarthritis (OA). Second, she was genuinely engaged in our conversation as I encouraged her to move more, get stronger, and lose weight—a discussion I’d had many times that day. I told her that if she did these things, I bet she wouldn’t need to see a knee surgeon anytime soon.

I’m an orthopaedic surgeon, not a weight coach or dietitian. Although managing OA is part of my role, I’d rather see patients when someone else has managed their OA and they’re ready to talk about joint replacement. Yet this woman drove hundreds of miles to hear me talk about the basics of knee pain, OA, and obesity—a triad that affects so many people. That interaction drove home the value of effective communication skills—I felt a bit of pressure to make the drive worth her while! Thankfully, I’d had some training in this area as an alum of the former AAOS Communication Skills Mentoring Program, which was sunset in 2020. In that program, select AAOS Fellows participated in a 3-day empathy-focused communication course led by the Institute for Healthcare Communication. The course followed the “4E” framework, encouraging physicians to Engage, Empathize, Educate, and Enlist their patients.

Through this training, I learned how effective communication can improve healthcare outcomes and enhance well-being. Empathetic communication improves patients’ adherence to treatment plans, helps them adopt healthier behaviors (like my patient), and even saves time. It turns out that asking open-ended questions and listening without interruption—within reason—not only shows respect but also works well for gathering information, which leads to more accurate diagnoses and better clinical recommendations. When educating a patient on care and treatment options, ensure that the information is understood by checking their comprehension and addressing any questions. The final step is to enlist patients to actively participate in their healthcare decisions and collaborate on treatment plans that align with their needs and values. The result is a satisfied patient with the right diagnosis and a surgeon ready to move on to the next patient.

Communication skills are often simple. Greet your patient, say their name, and sit down—preferably with your eyes level with or below theirs. Ask open-ended questions, such as “How can I help?” or “Please tell me about your knee.” If they’re brief, prompt them with “Okay, tell me more about that.” Listening doesn’t come naturally to many of us, but we’ve all learned and mastered more challenging tasks.

Developing habits, such as saying “Many people tell me that” (normalizing), “That sounds really hard” (showing empathy), “What I’m hearing you say is …” (respectful reflection), or “What do you think is going on?” (acknowledging their perspective), can help you connect with patients with minimal effort. Nonverbal cues—such as sitting and leaning in or even simple gestures such as good hand hygiene—can show patients that you care about their well-being and safety. When discussing their pathology, a quick gesture to direct their gaze to the radiograph (and away from you) helps them associate you with solutions rather than their pain.

Six months after that first visit, my patient from eastern Oregon returned. I walked into the exam room for her follow-up and was surprised to see that she had driven across the state again. This time, she had come back to tell me I was right. She’d changed her routines and overcome her barriers to start exercising; she’d worked with her primary care physician (and her family and friends) to change her diet; and, just as I’d predicted, her knee pain was mostly gone. She thanked me, jokingly “fired” me, and left.

Katie Schabel, MD, FAAOS, is a professor of orthopaedic surgery, section chief of adult reconstruction, and medical director of episodes of care at Oregon Health & Science University.