When the first Americans became infected with the coronavirus two years ago, it became more critical than ever that communications between U.S. health care providers and their patients was effective. However, communicating about health information during the COVID-19 pandemic also became much more challenging, as it was a new virus, and much misinformation was circulating about it online and in print.
To help health care providers, who were treating patients suffering from tuberculosis, improve their communication skills during the pandemic, the Rutgers Global Tuberculosis Institute created a webinar titled “Communicating about Public Health in Times of Crisis: Strategies for TB Programs and Staff During the COVID-19 Pandemic.” Featuring recommendations by a variety of experts, the webinar was so effective that the Center for Disease Control and Prevention (CDC) used it.
One of the Rutgers faculty members the institute sought out to present research findings on the webinar was Associate Professor Lisa Mikesell, who is an expert in patient-provider communication and patient-provider relationships.
Mikesell, who is also an associated faculty member at the Rutgers Institute for Health, Health Policy, and Aging Research, said she spoke on the webinar about how healthcare providers can help their patients manage uncertainty and build connections, and how they can effectively communicate with patients who are experiencing grief, or loss and fear, or who may be misinformed.
Mikesell said she sought to communicate two main messages during the webinar. “First, to emphasize that patients’ relationships with their health care providers are just as important – perhaps even more important – during the pandemic and that we need to find ways to foster them, even when this can be challenging. Maintaining trusting relationships is good for both patients and health care providers so it’s a win-win.
“Second, to provide concrete and practical strategies for how to do that, given the number of challenges that practitioners are facing such as patients who have been misinformed or may not understand or recognize how to evaluate the evolving risks.”
Read our Q&A with Mikesell below to learn more of the recommendations she made during the webinar.
SC&I: What are some of the ways healthcare providers can best communicate with patients who resist their medical advice?
LM: On the practical side of things, in the webinar I wanted to emphasize that patients’ attitudes toward a particular health behavior, as well as the subjective norms from their community, and their perceived ability to enact a particular decision, all matter for whether they may engage in a recommended behavior, and there are ways healthcare providers can communicatively address these with patients who may be hesitant to engage in health behaviors.
Perhaps the most challenging is when our normative expectations and cultural narratives that we so strongly and personally value conflict with clinical values and professional norms. And although it is challenging, it’s important to recognize patients’ values and not dismiss them, because simply telling someone they are wrong is unlikely to be effective.
While health care providers ultimately want this patient to receive the health care services that they need, acknowledging their value systems (which does not mean validating them) when they are shared can go a long way in letting patients know “I hear you.” Patients across many contexts report that they do not feel heard, so this matters.
It’s also of course appropriate for health care providers to try to share their own professional and clinical values and communicate how they are relevant to a particular patient. Doing so can help communicate how these values are focused on the interest of the patient, essentially demonstrating that providers’ priority is to do the best they can to keep that patient safe and provide the best care they can.
We also discussed in the webinar how social connections can be built between patients and health care providers and why they are so important during this time. For example, many patients have told us anecdotally that, as much as the pandemic has been a challenge for them, they find it oddly comforting to be able to commiserate with their health care providers about a shared experience before the official business of the doctor’s visit is launched. So, in some ways, these shared moments can provide an opportunity for building connections, as strange as it may seem, given how many of our interactions are no longer in person.
SC&I: What are some of the enduring lessons for improving communication between healthcare providers and their patients, now that and many COVID-19 guidelines and restrictions are loosening (such as mask-wearing mandates)?
LM: The webinar was organized several months into the pandemic when it became extraordinarily clear that health care providers were facing a range of very difficult challenges, one of which was how to communicate about risk factors during a public health crisis, like the COVID-19 pandemic. There are so many strains on patient-clinician communication and challenges about how to best build and sustain trusting relationships with patients when there is such widespread misinformation.
Additionally, many patients – particularly those at risk – are reasonably cautious and delaying or canceling health care services, which is particularly concerning for clinicians working with patients with TB, who require regular care. This was and still is a time where many of us -- both patients and clinicians -- are experiencing heightened emotions including anxiety, fear, and frustration.
SC&I: Will you integrate the messages the webinar into your teaching at SC&I?
LM: The broader messages of the value of communication and trusting healthcare relationships is definitely something we discuss in my “Patient-Provider Communication” course. We discuss the nature of the patient-provider relationship and how patient and provider roles have been reconceptualized over time. We also read a selection of empirical studies detailing patient- and relationship-centered communication practices and their outcomes in both primary care and specialty care contexts.