When considering an optimized environment for compassionate patient communication, the chaotic emergency department (ED) probably gives some clinicians pause. EDs, filled with alarms, frequent interruptions, hurried paramedics and consultants, hallway beds, and the looming sense that clinicians are out of time, is rarely thought of as a place for empathetic communication. Indeed, the evidence would suggest that the environment is challenging. On average, physicians only allow patients to speak for about 18 to 23 seconds before an interruption.¹ Yet, empathetic communication is paramount to the patient-physician relationship.² Empathy is not feeling sorry for your patient or mere sympathy. Empathetic communication means listening to the total communication (words, gestures, or feelings) of your patient and letting them know you are really listening.³ Communication with patients is the most common task we do as clinicians. It is estimated that physicians each conduct about 150,000 patient interviews throughout their careers.² Hurried and fragmented histories can lead to diagnostic uncertainty and error.⁴ Algorithmic histories lacking empathy can leave patients feeling unheard and anxious.⁴ Worse, they won’t disclose critical information that would unlock the diagnostic puzzle. Depending on the clinical setting, patients typically share their story multiple times with nurses, advanced practice providers, residents, and attending physicians, creating an environment ripe for dropped information and fragmented relationships.

As challenging as soliciting information is, so is sharing it back with patients. Studies show that less than half of hospitalized patients could identify their diagnosis or name their medications at discharge.⁵ Despite how critical communication is, structured training on communication remains muted.⁶ If we approached patient interviews and communication the same way we approached any other procedure, the rates of error and patient frustration may decrease. There are, however, ways that we can optimize our communication with patients. Here, we share a framework of our Top 10 communication skills aiding in empathetic communication in the chaos:

1) Ask Permission

It is often difficult for a patient to feel any sense of control in a health care setting, let alone the emergency department. Asking permission allows the patient to feel a sense of control and prepare emotionally for the interview.

Example: “Would it be okay for me to share some of my concerns?” Or, “Is this a good time to discuss what brought you in?”

2) Name Any Dilemmas

Inevitably, problems arise when communicating with patients. To ensure clinician-patient alignment, any dilemmas need to be identified and discussed. This will help you as a clinician get a better sense of the patient’s perspective and provide goal-concordant care.