Posted June 22, 2011

Enhancing Communication Skills for Physicians: Beyond the Fundamentals of AIDET

By Wolf Schynoll, MD, FACEP

In the present-day medical era, patient perception of care has evolved to being dependent on the ability of the provider to match excellent clinical care quality with equally excellent communication quality. Physicians have relied on the use of communication tools such as AIDET® to aid them in their ability to practice effective communication with patients. However, the application of AIDET skills has remained challenging for physicians, as they have been slow to adapt AIDET into their daily practices. (AIDET is a communication tool that explains things to help reduce anxiety and stands for Acknowledge, Introduce, Duration, Explain and Thank You)

There are various reasons why this may be so. One is that physicians may not have a simple communication model to follow. If they did, it would show them how to imbed AIDET into their patient conversations and would help them remember the individual AIDET components.

As such, it has become evident that physicians are inconsistent in their ability to maximize their communication skills. It is also apparent that the components of AIDET represent the basic foundation of good communication, but there are other key communication attributes that also contribute to communicating well. A physician can be compliant with using all components of AIDET during a patient conversation, yet fail to achieve high patient satisfaction. The provider's use of AIDET alone does not result in achieving consistently great perception of care results.

When a provider uses the AIDET tool during a patient encounter, it helps to relieve patient anxiety and can drive compliance. The use of AIDET alone—without emphasis on the other key communication attributes—results in meeting, but not exceeding, patient expectations.

Meeting patient expectations yields a 3 or 4 on a patient experience survey and results in a "usually" response on an HCAHPS survey. To achieve a result of 5 on a patient experience survey or move to a culture of "always" on an HCAHPS survey, providers need to exceed patient expectations. They need to make sure the patient is at ease and has complete confidence in his or her care; this is, after all, what these result rankings are really about. In short, they need to "wow" the patient.

How does a provider "wow" a patient? By following the simple concepts outlined in the communication model below:

  1. AIDET communication components need to be used throughout the entire patient conversation.
  2. Equally important in the use of AIDET skills are the non-verbal communication attributes that influence patient perception. These include:
    1. Warm tone of voice and demeanor
    2. Engaging body language
    3. Consistent eye contact
    4. Showing empathy and appropriate use of touch
    5. Not coming across as rushed: demonstrating a relaxed bedside manor
    6. Showing appropriate emotions such as enthusiasm, positive attitude, and warmth
  3. Understanding that the above communication skills need to be imbedded into the three components that make up every patient encounter: the beginning, middle, and close. Maximizing the quality of each of these three components will yield a great patient experience. Here's how to create a best practice for each of the three components:

1. The Beginning
Goal: Creating a good first impression with every patient encounter

1. Knock on the door or announce through the curtain, "Hello, may I come in?" Wait a second or two for a response before entering the patient's room.
2. Smile. Acknowledge the patient by name and greet them in a warm and friendly manner.
3. Introduce yourself and the role you will play in their care.
4. Acknowledge all visitors and inquire who they are.
5. Sit down whenever possible.
6. Maintain consistent eye contact.
7. Begin the conversation with a very brief sentence or two on a non-medical topic. Show them that you are easy to talk to, do not come across as rushed, and show them you are genuinely interested in them as a person. Examples might include: the weather, their genealogy, recent travels, sports, or pets.
8. Now, begin your medical interview.

Total amount of time needed to create a great first impression: 60-90 seconds
AIDET components used: A, I, E

2. The Middle
Goal: Providing a great explanation to patients using language that they understand

1. Perform the history and physical exam.
2. Maintain eye contact when speaking.
3. Explain next steps in the plan of care: tests to be performed, approximately how long until results are back, additional people they will meet (e.g., respiratory therapist, CT technician, consultant, etc.), or any needed procedures (explain indications, risks, and procedure details).
4. If test and/or procedure results are completed during the visit, explain all findings.
5. Explain the three elements of their plan of care: what is the diagnosis or status of their condition, what is the proposed treatment, and what follow-up is/may be needed.
6. Use language patients can understand. Avoid using any medical jargon.

AIDET components used: D, E

3. The Close
Goal: Concluding the patient encounter with a strong ending

Ending strongly significantly influences patient perception of care and creates a lasting positive impression of the encounter. A strong ending will make patients feel that you listened well, answered all their questions, gave them a chance to participate in the decision making process, and will portray you as a more caring, sensitive, and attentive physician. There are a number of key words/phrases that should be imbedded into the closing conversation.

1. (Used selectively): If you sense that a patient looks confused, frightened, or anxious based on what you have told them, say: "What are you most worried about?" or, "I can sense that you are concerned or worried. Please tell me more."
2. Summarize the plan of care: "Let me summarize the plan of care so that both of us have a good understanding of what happens next." Summarize the plan of care by restating the diagnosis, treatment details, and follow-up instructions. After giving the patient your summary, ask: "How does this sound to you? Are you okay with this plan?" This allows the patient an opportunity to feel like they are participating in the decision making process and promotes better buy-in and compliance.
3. After you are finished explaining the diagnosis and treatment plan to the patient, say: "I want to make sure that I have thoroughly explained everything well to you. Based on everything I just covered, what questions do you have?" Pause until the patient answers.
4. End with a statement that makes the patient feel appreciated and lets them know you enjoyed meeting them. Create a phrase that fits your personality and use it consistently. Examples: "It was a pleasure meeting you today," "I hope you feel better soon," "I'm glad you came in to see me today," "I'm glad I was able to help you today," or, "I'm glad you are doing better."

AIDET components used: E, T


The ability to "wow" a patient and exceed their expectations will depend on the provider's skill in demonstrating effectiveness in their non-verbal communication, use of AIDET throughout their conversation, and creating a best practice style in the three components of the patient encounter. Consistent use of this communication model will maximize patient perception of care and positively impact clinical outcomes through improved compliance. It's not only the right thing to do, but it makes us all better physicians.


Wolf Schynoll, MD, FACEP

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