Acknowledgement

Acknowledging what a patient has expressed, shared, or asked helps build rapport and trust by showing the patient we are listening and paying attention to them. There are different ways to accomplish this—displaying empathy, sharing a strengths based positive, finding agreement, or validating. Whatever way you decide to do this, it is essential that the sentiment you express is authentic and based on your true response the individual based on what you have heard. 

Acknowledgement Skills 

Empathy

Central to person-centered communication is expressing empathy— verbally and non-verbally—by acknowledging and reflecting a patient’s feelings. Empathy means communicating that you care about another person’s feelings and experiences. When someone expresses an emotion, acknowledge it. This is respectful, kind, and only takes a few seconds. Empathize by acknowledging the impact of their feelings and communicating that their reaction is understandable and perhaps common to others in similar situations. 

Phrases to demonstrate empathy without labeling specific emotions

  • “I can see that was really concerning to you.”

  • “It seems like that was hard to deal with!”

  • “That situation must be very difficult to manage”

  • “I can’t even imagine how that must have been for you.”

  • “Wow…”

Positive 
Feedback

Build rapport and trust by noticing and pointing out positives. Take care not to pander by giving generic “praise” that is not specific to the individual. People can tell when someone is giving an insincere compliment. Pay attention to the positives so you can give genuine positive feedback; point out health-supporting behaviors and acknowledge health-related knowledge. This demonstrates to your patient that you appreciate them for who they are as an individual and that you are on their side.

Examples

  • “It’s great that you were so strong in standing up for yourself during...  [fill in a situation...]”

  • “You’ve clearly thought about this a lot...  so what do you make of this situation?”

  • “You ask really great questions...”

  • “I’m impressed that even with all of those challenges, you’ve been using a condom every time."

  •  “You are clearly interested in protecting yourself.”

  • “Wow, I wouldn’t have thought about that. You’re right.”

“Yes and…”! 
a.k.a finding agreement

When you find yourself wanting to correct a patient, or saying “that’s wrong/incorrect,” “no,” or “but,” consider instead the following strategy:

  1. Look for what is factually correct in what they are saying and point it out (In other words, a Yes!)

  2. Say AND...

  3. Then build on it by adding the information you would like them to know.

Example: Patient concern about fertility:

Patient: "I don't want to go on birth control because I want to have kids later and I don’t want to mess with that."

Provider:  "Yes, I hear that from my patients a lot! I can see that it is important to you to be a parent someday, and you don't want anything getting in the way of that. You're right that with one of the methods, the shot, it can take a while for someone’s ability to get pregnant to go back to whatever is normal for them. With all of the other methods your ability to get pregnant will go back to whatever is normal for you immediately after you stop using it."

Non-Verbal Communication

People respond to one another’s non-verbal communications and the non-verbal aspects of provider-patient communications have tremendous impact on the relationship and the patient’s emotional response to the interaction.

 

Non-verbal communications and suggestions:

  • Sit down to position yourself at or below the patient’s level

  • Eye contact:

    • Avoid looking away (towards the EMR etc.) look in the patient’s direction

    • Return the patient’s gaze and look at them when they are speaking. Depending on cultural norms eye contact may be uncomfortable, so it is best to take your cue from the patient’s eye contact

  • Lean forward to indicate interest in what the patient is saying

  • Smile in response to positives

  • Gestures and nods of agreement

  • Vocal utterances of interest to encourage the patient to continue; mm hmm, huh, ahh, yea

  • Respectful interpersonal distance; not invading patient’s personal space during conversations

  • Open body posture; arms not crossed

  • expressive tone of voice

  • empathetic facial expression 

  • Moderate level of speech; audible but not too loud