Diagnosis & Treatment:

Effective Communication Strategies

for Healthcare Providers of those with Autoimmune Diseases

Global Autoimmune Institute August 9, 2023

Effective communication between healthcare providers and patients is crucial for optimizing treatment outcomes, improving patient satisfaction, and enhancing overall healthcare experiences.

“Where there are issues around communication is where you have a disease without any structural abnormalities,” says Douglas Drossman, co-author of Gut Feelings: Doctors and Patient-Centered Care. How Knowledge, Commitment to Care and Empathy Improve Patient’s Lives.

“In many cases, symptoms may be silent.”

How can a provider better communicate with a patient, particularly when it comes to an autoimmune disease? 

The Global Autoimmune Institute expounds on key tips set forth by Dr. Drossman and co-author Johannah Ruddy, M.Ed. to understand symptoms, needs, perceptions and concerns related to patient health.

1. Get to know the symptoms — everyone is different

Understanding symptoms of autoimmune disease while acknowledging the uniqueness of each patient’s experience is key.

Autoimmune diseases are diverse and encompass conditions as varied as rheumatoid arthritis, lupus, multiple sclerosis, and celiac disease, among others. While some symptoms may overlap across different diseases, presentation and severity can vary significantly. 

It’s crucial for physicians to be well-versed in characteristic symptoms, diagnostic criteria, and the potential course each autoimmune disease can take. 

According to Dr. Drossman, patients often leave issues unaddressed because they haven’t been given an opportunity to speak about them, or were not previously aware of what they were feeling. 

Physicians should use open-ended questions to gather detailed information about the patient’s symptoms, their impact on daily life, and any potential triggers or patterns. This approach can provide clues that may lead to a more accurate diagnosis or treatment plan.

Dr. Drossman advocates for physicians asking four questions during an initial visit.  1. What brought you here today? 2. What do you think you have? 3. What worries or concerns do you have?  4. What do you feel I can do to help?

2. Take time to listen

When communicating with patients, the importance of active listening cannot be overstated. Patients with autoimmune diseases often have complex medical histories and may have multiple symptoms that can be difficult to untangle. There may also be atypical or rare presentations, as some patients may have subtle or less common symptoms. 

Taking the time to listen, pay attention to language and subtleties, and allow patients to express their concerns and experiences is important. 

As Dr. Drossman elucidates: “You want to listen actively, rather than jump in.” 

Additionally, some issues may have a psychosocial component that may not be causing disease, but could be exacerbated by it. 

Removing any stigma is key. 

“If patients have symptoms of depression and anxiety, providers can help them to fully understand what that means.”

3. Empathize, don’t sympathize, to put a patient at ease

Physicians should be empathetic and validate a patient’s experiences, even if symptoms are atypical or seemingly unrelated. Often, acknowledging a patient’s journey and frustrations can help build trust and strengthen a relationship.

“It can be unhelpful and invalidating to tell a patient with an autoimmune condition that they should be grateful for not having a particular disease,” says Ruddy, M.Ed., who is also a doctoral candidate at Campbell University as well as a patient advocate.

“Offering patients knowledge about their symptoms with empathy provides validation and builds trust,” she says. 

Dr. Drossman has noted that an empathic statement incorporates four components: 1. Perspective taking: Seeing the world as the patient sees it. 2. Being non-judgmental. 3. Recognizing emotions and understanding a patient’s feelings.  4. Communicating that understanding.

As one example, Ruddy recommends using a script like the one below: 

“These test results came back within the normal range which means you do not have XYZ causing your symptoms. I want to further investigate but, in the meantime, I empathize with how much these symptoms have impacted your life and how much you have been suffering. 

Based on your symptoms, we know that you meet the criteria for ABC condition, and that is encouraging because we can now collaborate on a plan to help you feel better.” 

4. Be patient, answer questions, and give sources

Some patients may take more time to articulate their thoughts or may feel hesitant to share sensitive information. Patients may also be anxious, scared, or uncertain about their condition. 

As a physician, a compassionate and understanding demeanor can go a long way in making patients feel comfortable and heard. 

“Validate what patients are experiencing, rather than telling them what they should do,” says Dr. Drossman. Though a physician may not necessarily agree, he or she is still accepting the patient’s perspective as legitimate. 

For example, a validating statement for a patient who feels stigmatized by others who say their problem is due to stress would be: “I can see you are upset when people say this is due to stress when you know there are other factors.” 

Likewise, encouraging patients to ask questions about their condition, treatment options, or any other medical concerns can be helpful.

Providing credible sources or reputable websites where patients can find additional information can go a long way toward empowering patients to feel informed and involved in their healthcare decisions. 

“It is crucial to provide patients with scientific education about their condition and a rationale for a fully integrated management approach that includes dietary, behavioral, and complementary therapies,” says Ruddy.

She also says that patients want to be well-informed about their illness, and not just given a simple brochure with limited information. 

“Providing more information about the integrated care process that takes a fully biopsychosocial approach can help patients manage their treatment expectations and understand their role in the management process,” Ruddy says.

In Dr. Drossman’s view, education is a four step iterative process: 1. Elicit the patient’s understanding 2. Address misunderstandings 3. Provide information consistent with the patient’s understanding  4. Check the patient’s understanding of what was discussed

5. Encourage follow-up visits; set realistic goals

Memory and thought are not linear. A patient’s experience is complex, and there are numerous challenges involved with retaining and processing medical information during a single visit.

Over time, physicians can reinforce information to ensure that patients have a clear understanding of their condition, treatment plan, and any necessary lifestyle changes. 

Likewise, scheduling follow-ups allows physicians to address emerging issues, potentially preventing further complications. 

Illnesses may take a long time to cure, or they may involve ongoing management. 

Dr. Drossman has suggested the following line: “I can understand how much you want these symptoms to go away, but they are longstanding, and as such we need to reset our expectations. If we could seek to reduce your symptoms by 30% over the next several months would that help?”

6. Help the patient take responsibility

Dr. Drossman believe a better understanding can come about by speaking with a patient and allowing them to set their goals and understand their agenda.

For example, rather than asking a patient: “How is your pain doing?” Dr. Drossman has suggested asking: “How are you managing with your pain?”

“Care should be collaborative,” says Dr. Drossman.

“You want the patient to own their illness and take responsibility because self-reliance has a much better outcome than a patient passively doing what the doctor says.”