American Association for Physician Leadership

Quality and Risk

The Art of Patient Communication and Compliance

John Guiliana, DPM, MS | Hal Ornstein, DPM, FASPS

June 14, 2024


Getting your patients to say “yes.” Presenting your treatment plan and getting patients to follow it.

Patient compliance is completely linked to a physician’s communication skills. Fundamentally, we feel that there needs to be a shift away from being a “doctor” and a shift toward being a “caregiver.” A caregiver carries less baggage than a physician and the word by itself suggests the patient’s best interests are at heart. In other words, a caregiver persuades a patient to do what is best for the patient; they get them to comply.

A noncompliant patient is the bane of healthcare and several studies suggest that noncompliance costs the U.S. healthcare system more than $100 billion annually. Much of that noncompliance is the fault of physicians and poor communication skills.

We present 6 rules for improving caregiver-patient communication, which can lead to higher levels of patient compliance.

1. Active listening. It’s not enough to simply listen to a patient’s words. You need to learn to listen to the patient’s emotions that those words convey. There’s an important word to describe this: Empathy. By connecting with the patient emotionally, you reflect back their emotions, which is a powerful bridge to credibility and trustworthiness, the building blocks of persuasion.

2. Decisiveness. Not only does the physician need to be decisive, the physician needs to communicate in a decisive manner. Physicians often use words or phrases such as “I think” and “maybe,” but those can instill doubt and even confuse patients. Alternately, words such as “critical” and “essential” are perceived as decisive and add weight to the physician’s message.

We recommend that you even prepare scripts for your most common presentations. Craft those scripts so they flow and sound natural, but also to eliminate any vague or wishy-washy sounding language. An example:

Poor: “I think you might need an antibiotic for this infection.”

Good: “It’s essential that we get you on an antibiotic so you can get well faster.”

Part of the strategy is to incorporate what the patient wants and needs into your delivery. What does the patient want? To feel better sooner.

3. Association. It’s important when you are crafting your scripts that you make the language accessible to the patient. Patients are often confused by medical language, but won’t necessarily express that confusion to you out of embarrassment or for fear of appearing stupid. One way to improve your communication with patients is to associate medical terminology with more common language. An example:

Poor: “I think you need an orthotic for your heel pain.”

Good: “In order to help you resolve your pain, it’s essential that I get you into an orthotic. Orthotics are removable inserts made by an impression of your feet. They help control the mechanical weakness in your feet, much like eyeglasses control weakness of the eyes.”

4. Contrast. Not only explain the value of a proposed treatment plan, but describe what could happen if the patient doesn’t comply. An example:

Poor: “I think you need an antibiotic to clear up this earache.”

Good: “It’s critical that we clear up this earache quickly, using an antibiotic so it doesn’t spread into a full-fledged sinus infection. And it’s important that you complete the prescription and take all of the medications, not just until you feel better. If you quit too early, the infection may come back tougher than ever and run the risk of being resistant to antibiotics.”

5. The Two-by-Four Rule. By any other name this is: You never get a second chance to make a first impression. Basically, research tells us that the impression you make on someone in the first 2 seconds upon meeting them takes 4 minutes to change. So when, as a physician, you enter the examining room, your immediate impression on the patient will have a lasting effect on your credibility and trustworthiness. Dress appropriately, professionally, and neatly. Make eye contact and maintain good posture. Avoid condescending language. Be friendly. Smile!

6. UPOD. An excellent acronym that stands for: Under-Promise and Over-Deliver. Although we recommend you be decisive in your language and avoid waffling, any physician knows that there are no 100% guarantees in medicine. Be careful of words such as “always” and “never.” Use words such as “likely” to avoid making promises or guarantees.

In addition, we feel there are nuances you can bring to your patient-physician communications, or perhaps this is a good time to emphasize patient-caregiver communications. There is great value in the power of touch. That can begin with a handshake and, in many forms of physician-patient interactions, there are reasons to appropriately touch a patient. Studies show that, for instance, taking a patient’s foot or hand in both hands conveys compassion.

Stay away from yes-and-no questions. Start your interaction with a question related to the patient’s overall health and well-being, such as “How have you been?” This type of open question can, unfortunately, lead you offtrack if you have a chatty patient, so you need to be able to focus the conversation to the particular problem the patient comes in for. So, another opening gambit might be, “So, what brings you here today?” Be careful about interrupting the patient early in the encounter, because this will make the patient feel rushed.

Patients already assume you provide quality medical care. What gives you a competitive edge are your people skills. Mary Kay Ash, the founder of Mary Kay Cosmetics, claimed that the secret of her success was to make people feel important. In our medical practices, the goal isn’t just to provide care, but to make all our patients feel special, that they are our top priority. To that end, the physician needs to not just aim for a satisfied patient, but a “Wow” experience. This starts from their very first contact with your staff in the form of the telephone call or when the patient walks through the door.

We believe the phone should be answered in fewer than 3 rings. Whoever answers the phone provides their name in the greeting and, if it is necessary to put the patient on hold, asks for their permission to do so. Thank them for holding and, at the end of the conversation, make sure your staff asks if the patients have any questions or need anything else. Your staff should be encouraged or trained to make eye contact with patients and smile. If you’re running behind, patients should be informed of the wait.

Be aware of and attentive to The Doorknob Moment. The Doorknob Moment involves this scenario: The physician stands up to end the patient visit, but before standing up asks if the patient has anything else they want to discuss. The patient says, “No.” The physician stands up to leave, puts his or her hand on the doorknob, and the patient says, “There is one thing . . .”

Often, the thing the patient really has on her mind is the very thing she brings up at the last minute. (Not always, but often). Often, it’s a major issue. Part of this phenomenon may be tied to the results of a study conducted in the 1980s that found doctors interrupt patients on an average of just 18 seconds into a routine office visit, making patients feel rushed.

One technique to decrease The Doorknob Moment is to provide a patient with a 3x5 index card and a pen or pencil when they arrive. Have your staff tell them to write down any questions they may have for the physician that day.

Another way to avoid this is to actively listen and to simply ask, “Is there anything else I can help you with today?”

Action Step: Create effective scripts for your 5 most frequent patient dialogues, for both the front office and the clinical team. Practice the scripts regularly at special office meetings. Add 5 new scripts monthly until all are completed.

Excerpted from 31 ½ Essentials for Running your Medical Practice by John Guiliana and Hal Ornstein.

John Guiliana, DPM, MS

John Guiliana, DPM, MS, is the managing partner of a four-doctor podiatry practice in Hackettstown, NJ. He holds a master’s degree in healthcare management and is a nationally recognized professional speaker and author on medical practice management. He is a frequent contributor to Podiatry Management, Podiatry Today, and is author of Talking Practice Enhancement, an American Podiatric Medical Association news column.

Hal Ornstein, DPM, FASPS

Hal Ornstein, DPM, FASPS, serves as Chairman and Director of Corporate Development of the American Academy of Podiatric Practice Management and Consulting Editor for Podiatry Management Magazine. He has given over 200 presentations internationally and has written and been interviewed for over 250 articles on topics pertinent to practice management, patient satisfaction and efficiency in a medical practice. Dr. Ornstein has been in private practice for 18 years and serves as Medical Director of Affiliated Foot and Ankle Center, LLP with their main office in Howell, NJ.

Interested in sharing leadership insights? Contribute

For over 45 years.

The American Association for Physician Leadership has helped physicians develop their leadership skills through education, career development, thought leadership and community building.

The American Association for Physician Leadership (AAPL) changed its name from the American College of Physician Executives (ACPE) in 2014. We may have changed our name, but we are the same organization that has been serving physician leaders since 1975.


Mail Processing Address
PO Box 96503 I BMB 97493
Washington, DC 20090-6503

Payment Remittance Address
PO Box 745725
Atlanta, GA 30374-5725
(800) 562-8088
(813) 287-8993 Fax



AAPL providers leadership development programs designed to retain valuable team members and improve patient outcomes.

American Association for Physician Leadership®

formerly known as the American College of Physician Executives (ACPE)