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Communications consultant and attorney Heather Hansen discusses her article, “Why every doctor needs a translator.” Drawing on her background as a medical malpractice defense attorney, she explains the “curse of knowledge,” where physicians, once expert, find it difficult to imagine not knowing complex medical information, leading to communication barriers with patients. Heather argues that doctors must become effective “translators” of medical jargon into plain language, noting that research found only two percent of sample orthopedic patient materials met sixth-grade readability standards. She presents a three-step process for physicians to overcome this challenge: Be Curious (actively ask patients what they understand, not just if, and involve staff), Be Compassionate (use curiosity to truly see from the patient’s perspective, recognizing clear communication is kind), and Build Credibility (explain the ‘why’ behind instructions clearly to foster trust and belief). Heather contends that mastering this “translation” skill improves patient outcomes, strengthens relationships, reduces legal risk, and can even lessen physician burnout.
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Heather Hanson. She’s a communications consultant and attorney. Today’s KevinMD article is “Why every doctor needs a translator.” Heather, welcome back to the show.
Heather Hanson: It’s so good to be back.
Kevin Pho: All right, you’ve been on in the past. We’ve been talking offline; it was more than three to four years ago. Briefly introduce yourself and then talk about the KevinMD article we’re going to discuss today.
Heather Hanson: Happy to. I defended medical providers in medical malpractice cases for 25 years, and I loved it, and it was enormously stressful for my clients and for me. Now, I do communications and strategy consulting. I work with doctors on communication and also to prepare them when they are facing a trial.
One of the things that I did in that role and what I write about in that article is overcoming what I call the curse of knowledge. Doctors and medical providers in general know things so well that they forget what it’s like not to know them. So fetal monitoring strips, stroke, enteric wires, osteomyelitis: all of these things that are normal words to various specialties are not normal words to our jurors. The ability to translate those words in a way that the jury understands them was my job.
I know from all of those years of doing that work that if doctors and providers can learn to do that on their own during the care at issue, a lot of times that actually prevents lawsuits. In a more proactive way, it also improves HCAP scores, it improves patient compliance, and it improves the relationship between doctor and provider and patient. It’s really imperative for all of us to learn how to communicate in a way that’s clear on both sides.
Kevin Pho: Take us behind the scenes of one of those coaching conversations with doctors in terms of clearing up their jargon and making sure that they communicate in plain language. What are some of those sessions like?
Heather Hanson: Much of it is just starting to recognize where that jargon lies and to see things from a different perspective. The easiest way to illustrate it when we are in the courtroom is the courtroom is such a new environment for a provider that they feel out of place; they don’t understand. They’re confused by things. It’s a great way to say, “This is how your patient feels.”
For me, going to trial, I did it all the time, Kevin. But for the doctor, ideally, it’s the first and only time that they’re stepping into that environment. It’s the same thing for a patient. Doctors, surgeons do surgery every day. But for a patient, hopefully, it’s the only time that they have to do that. Putting yourself in those shoes in any way that you can is imperative.
Now, there is a difference. One of the things that I talk to doctors a lot about is that you don’t have to feel empathy in an affective way. There are two types of empathy: cognitive empathy and affective or emotional empathy. I actually think that doctors don’t need to push themselves to feel what their patients feel because oftentimes that’s pain, fear, anxiety, irritation, frustration. None of those feelings are effective. But to see things from another perspective is enormously valuable in learning how to communicate in a way that the patient is going to understand.
Kevin Pho: I could also imagine when a physician is in a courtroom, that’s obviously an unfamiliar, high-pressure environment, so they’re just going to reflexively fall back on their training, which is to speak in medical jargon.
Heather Hanson: Absolutely. Also, a lot of times—and this isn’t only providers; I’ve worked with people in other specialties that do this too—they think the jargon actually makes them look smarter. But the truth is, one of the things I talk about in the article is building credibility. I have in my work a belief triangle. The jury—and sometimes in the courtroom, the jury is the jury deciding the case, but for you tomorrow, your jury is your patient whom you want to persuade to take a certain medication.
The Belief Triangle says they have to believe you: that when you set an expectation, you’ll meet it; when you make a promise, you’ll keep it. They have to believe in you: your curriculum vitae, your experience, your training. But most importantly, the foundation of that belief triangle is they have to believe that you can help them.
It’s really the ability to see the world through the patient’s perspective. What is most important to them after this knee replacement? Do they want to run a marathon, or do they want to be able to pick up their grandkid and take them into the car? When you understand those things, you can speak to your patient in a way that you’re truly making a connection and you’re building that credibility.
Kevin Pho: In your article, you introduce a paradigm where a doctor is a translator. Tell us more about that concept.
Heather Hanson: I think that the ability to translate those very challenging medical terms in a way that the patient actually understands is going to serve the provider in so many ways. A patient is more likely to be compliant when they understand the “why” of what they’re doing. Why do I have to take this medication? Why is it helpful for me to lose some weight before I have the surgery? Why is prehab so important? Learning to go back and translate those things is key.
It’s interesting because you talk a lot on your show about AI. AI is going to be a huge part of medicine, and in many ways, it’s going to be a huge translator. I heard Bill Gates on a podcast talking about one of the primary uses of AI that he uses: he drops in medical records and says, “Explain this to me like I’m in fifth grade.” You can direct your patients there, but if you want to build a connection with them, have that conversation with them. Explain it to them in a way that they are going to understand. Translating those things is going to make that relationship so much better for you as well.
Kevin Pho: Tell us some simple tips that physicians can implement in the exam room or in a hospital to better communicate and maybe act more as a translator, so they’re not reflexively speaking in medical jargon. How could they improve their communications so patients can better understand and connect with them?
Heather Hanson: OK. The first thing that I have to say is I know as I say these things, you’re all going to say this takes too long. But the truth is that a few moments of time in that office are going to be a lot less time in litigation if you’re ever sued. Depositions take a long time. Trial takes a long time.
So, for example, one of the things I recommend is slowing down. Especially with office hours, I know how busy you are. I do understand it. At the same time, there’s a lot of research that shows that doctors interrupt patients within seconds of them talking. But the other part that we don’t talk about enough is that if they don’t interrupt, the patients don’t go on for 10 minutes; they tend to go on for something like one to three minutes. So slow it down.
The other thing that’s important to note about slowing down is that slowing down brings you more authority. It changes your body language. It changes your tone of voice. That brings you back into your credibility, and that’s going to make it a better relationship as well. So slowing down is one thing.
Another thing that I often talk about is this exercise that I do, and we can describe it here. You ask the person—and we can do this together—you snap three times with your dominant hand and draw a capital E on your forehead with your finger. Now, I won’t have you do it, Kevin, because I don’t want to call you out as to where you are today, but those listening, if you think about it, there are two ways you can draw that E. You could draw the E facing yourself as if you’re looking at it from your own eyes, or you could draw it from the other person’s perspective. If you draw it from the other person’s perspective, it’s a sign that you’re seeing the world through their perspective.
I remind doctors to think about that exercise as you walk into the office. What are they seeing instead of what are you seeing? We lose the ability to do this as we get more powerful. Residents are probably better at that exercise than an attending is. You want to stay as good at that as possible. Some of the ways you do that is by checking in with your residents, checking in with your PAs, your nurses, your ancillary staff, and seeing what they see, what they know.
Then ask questions, not just questions about “What are your symptoms?” and “Why are you here?” but “What does a good outcome look like for you?” Don’t just assume that it’s the ability to play golf. It might be something as simple as the ability to get up and go to the bathroom in the middle of the night.
Kevin Pho: That last question is a great way to gauge patients’ values because a lot of times in the exam room, there’s normally a menu of options. There’s no right or wrong way. What I recommend for one patient may be completely different for another simply based on their values. So that last question is a great gauge of that.
Heather Hanson: It is, and it’s a way to build a relationship. I get really frustrated. I had a gentleman named Dr. Steven Trzeciak on my podcast when I had it, and he wrote a book called Compassionomics. It’s a big, fat, amazing book about the ROI of compassion in medicine. It’s all about compassion for the patient, and that’s great.
But I have asked him and other doctors that I’ve met, “What about compassion for you?” Doctors always say, “Wait, what? I don’t even know. I’m very uncomfortable with that idea.” But I do think that we patients should be extending compassion to our providers. You are overworked; you have this burnout, especially since COVID. The health care system is also beating you up. I think that if this can be a give-and-take relationship and not the old-school patriarchal relationship, it’s going to serve both sides of that equation.
Kevin Pho: What’s your commentary about the current state of the health care system regarding things that are outside a clinician’s control? Because the way I see it, a lot of the things that you and I value, like communication, time spent with patients, building relationships—that’s often not so much valued by, say, our health care insurers or by private equity companies, for instance, that buy a lot of these practices. So how do you reconcile what you’re proposing in terms of taking that extra time, slowing it down, and better communicating with patients versus the climate that we have to practice in today?
Heather Hanson: It’s a challenge, right? We know systems issues are usually the reason for lawsuits, and systems issues often contribute to burnout. But if we think of the systems issues originating with a human being or human beings, then it’s really a matter of education. If the private equity firms, for example—they’re about the bottom line—if they understand that the bottom line gets better when there is this communication.
There have been all kinds of attempts to make this happen with bundled billing and all of that. Yes. But there really has to be an understanding that things are not the way that they used to be. The new NIH director, I recently heard him on a podcast talking about the fact that scientists have to be willing to say, “I don’t know.” I do think that doctors have to be willing to say the same and work things out with their patients as partners.
That does take more time than just simply saying, “Here’s a procedure, here’s a prescription. Go do it and see you later.” They’ll learn easy, or they’ll learn hard. But the people at the top are going to learn that what they’re doing now does not work. It doesn’t work for the provider or the patient.
Kevin Pho: Tell us a success story, maybe a before-and-after scenario where you made some changes in a specific physician and changed their communication skills to implement some of what we’re talking about today. Talk about the outcomes. Tell us a success story.
Heather Hanson: I’ll tell you a story that is my favorite story to tell. I had a doctor who I took through a deposition, and he was angry, understandably so. Doctors don’t go to work to hurt people, for the most part, almost all the time. They are sad and frustrated and, yes, angry—usually not at the patient, but at the patient’s attorney. This particular doctor was very angry, and no matter what I said to him, he was not able to manage that anger at deposition. He really flew off the handle.
As a result—one of the things doctors should know is in many jurisdictions, plaintiff’s attorneys share that information. They share if you’re not the best witness, if you’re a witness that they can get to pop off—that doctor then got sued again. It was in pretty quick succession after that case because one of the things that plaintiff’s attorneys often look for is damages and a bad witness. Then they’ll use that to create liability. He got sued again.
We had another deposition, and I begged him. I said, “Just give my way a chance. Let’s talk about your energy, let’s talk about your tone, let’s talk about thinking about the enemy.” One of the things I always talk about is the enemy is not the opposing attorney; the enemy is confusion. If you can slay confusion, you will win. I said, “Please just try it my way.” And he did.
At the end of the deposition, the plaintiff’s attorney pulled me aside—and this never happens—and said, “I’m going to drop the case.” Right? So that in and of itself was a win. But the bigger win, Kevin, was that doctor attributes his increase in patient reviews going up, his HCAP scores going up, because of the way that I taught him to communicate a little bit differently: being aware of his tone of voice, being aware of slowing down, laughing with the patient, touching the patient appropriately. All of these things that I teach people in preparation for trial are also really helpful when you’re dealing with the patient. That doctor went from a really problematic deposition to a very unusually successful deposition, to that then running off into his practice itself.
Kevin Pho: We’re talking to Heather Hanson. She’s a communications consultant and attorney. Today’s KevinMD article is “Why every doctor needs a translator.” Heather, let’s end, as always, with some take-home messages you want to leave with the KevinMD audience.
Heather Hanson: I think the first thing is we need to focus not so much on authority anymore, but on credibility. It’s all about belief, right? It’s like the placebo effect. We know that that’s potentially a big part of a patient’s healing and progress. You want to make sure that patients believe you. That means that you make promises and you keep them; you set expectations and you meet them.
The problem with that is sometimes you can’t, right? You’re running late. But then own it. Own it when you don’t know the answer. Own it when you’ve run late. Say, “I’m sorry you’ve had to wait.” It’s no skin off your nose, and it does build your credibility.
Then, continue to keep up with the changes in the medicine, the peer-reviewed articles, knowing the difference between peer review and what’s found on the web on Google, and being able to explain that to patients. Really get to know your patients so that bottom of that belief triangle—they believe that you can help them—and their values, as you pointed out earlier, Kevin, and what they want from the outcome, are clear.
Kevin Pho: Heather, as always, thank you so much for sharing your perspective and insight. Thanks again for coming back on the show.
Heather Hanson: Thanks for having me.