One Key To Empathy: Ask, 'What Else?'

Posted Oct. 27, 2014

By Laura Selby

joshua-miller.jpg"Communication is the most common medical procedure you do." So says Joshua Miller, DO, FACP, who's medical director of the Cleveland Clinic Willoughby Hills Family Health Center and associate medical director of Cleveland Clinic Regional Operations, noting that physicians typically conduct over 200,000 patient interviews during their careers. Building strong relationships improves patient experience, he said, which has been shown to result in better health outcomes. It's also good for physicians; happy, loyal patients are less likely to file malpractice suits and good communication reduces staff burnout and turnover. In addition, patient experience is increasingly tied to physician certification and compensation, and it's also a major factor in doctors' ratings on websites like

Relationship-Building Tips

To improve patient experience, Dr. Miller explained, you should work to establish, develop and engage authentic relationships. Here are some of his tips for achieving that goal.

  • Make the patient feel valued when you greet them. Dr. Miller likened this to the graciousness you would extend to guests at a dinner party: "You don't just grab their coat and immediately sit down at the table and start eating."

  • Ask the patient what brought them in and listen without interrupting. Then continue asking, "What else?" until the patient has shared all their concerns. This may sound time-consuming, Dr. Miller noted, but it actually saves time by reducing last-second "doorknob questions" at the end of the appointment.

  • Use verbal and nonverbal ways of showing empathy during your conversation. Don't try to integrate tactics that don't feel natural; "the key to empathy is, it has to be authentic to you," Dr. Miller said.

  • Ask patients for their ideas about what's behind their health concerns, what outcomes they hope to attain and what worries them most about their situation. Acknowledge and validate their emotions and let them know they have your support.

  • Work with the patient to develop a treatment plan by giving them several options and asking which they would prefer. After you've settled on a plan, check for understanding: "I want to be sure I've explained everything clearly. What are you going to do when you get home?"

Developing strong relationships with patients, Dr. Miller said, is extremely rewarding for patients and physicians alike. "So many times, patients will walk out of my office and say, 'Doc, I feel better already,' " he related. "I didn't write a prescription. I didn't do an MRI." At the end of the day, he said, the most compelling reason to strive for better communication with patients is also the simplest: "It's just the right thing to do."