The quality of a clinical exchange is not measured by its duration, but by the structuring of the information conveyed. Improving communication with patients first requires reproducible, measurable methods that are adapted to the real constraints of practice.
Structuring the clinical exchange with the Saed tool
The Saed (Situation, History, Evaluation, Request) tool, validated by the Haute Autorité de santé in 2014, remains underutilized in caregiver-patient exchanges even though it was designed to secure the transmission of information between professionals. Its adaptation to direct consultations with patients, however, provides an immediate framework.
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The principle: break down each message into four blocks. First, the current situation (reason for consultation, main symptom). Then the relevant history, without overwhelming the patient with exhaustive background. The evaluation then provides your clinical analysis, formulated in an accessible manner. The request concludes the exchange by clarifying what you expect from the patient (additional examination, treatment modification, home monitoring).
We observe that practitioners who apply this breakdown reduce misunderstandings regarding post-consultation instructions. The patient leaves with a clear mental structure, not a continuous verbal flow. To deepen communication with patients, this Saed framework serves as a solid starting point before addressing relational dimensions.
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PROM and PREM: measuring what the patient really understands
Talking about communication without measuring it is like driving without a dashboard. PREM (Patient Reported Experience Measures) specifically evaluate how the patient experienced the care process: quality of reception, clarity of explanations, coordination among caregivers. PROM (Patient Reported Outcome Measures) capture their perception of the evolution of their symptoms and quality of life.
The interest for the practitioner is concrete. PREM allow for the identification, service by service, of breakdown points in the information chain. A low score on understanding discharge instructions, for example, points to a problem with formulation or timing, not necessarily with relational competence.
The OECD now incorporates these indicators into its performance evaluation frameworks for health systems, particularly in the sub-domain of patient respect. We recommend that care teams not wait for an institutional approach to integrate a short PREM questionnaire at the end of a consultation or care pathway. Three to five targeted questions are sufficient to bring up actionable signals.
Which items to prioritize in a PREM questionnaire
- The perceived clarity of the explained diagnosis: can the patient rephrase what they understood in one sentence?
- The feeling of having been able to ask questions without being interrupted or rushed for time
- The consistency of the information received among different caregivers (primary care physician, specialist, nurse)
- The understanding of the next steps: does the patient know exactly what to do upon leaving?
Teleconsultation and communication: adapting the channel without degrading the message
The digital channel modifies the conditions for receiving the clinical message. In teleconsultation, non-verbal communication is partially amputated: peripheral gaze, posture, and observation of the patient’s spontaneous gestures disappear or are reduced to the frame of a camera.
With about 1.2 million teleconsultations conducted each month in France, the question is no longer whether this channel is legitimate, but how to maintain a level of communication equivalent to in-person consultations. We find that practitioners who apply the same conversational framework as in the office achieve lower patient understanding results.
Specific adjustments for teleconsultation
The pace must slow down. Each key piece of information requires explicit oral validation from the patient. The teach-back technique (asking the patient to rephrase what they just heard) takes on its full value here, as you cannot read on their face if they have disengaged.
Visual support compensates for the loss of non-verbal cues. Sharing an anatomical diagram, an annotated prescription, or a summary document during the video anchors the information. Visual aid tools used in teleconsultation show encouraging results on therapeutic adherence, provided that the practitioner integrates them into the flow of conversation and not at the end of the session like an administrative document.
Interprofessional communication: the link that the patient silently endures
A patient who receives contradictory information from their primary care physician and their specialist loses confidence in the entire care pathway. Communication failures among caregivers directly translate into communication failures with the patient.
The Sermo survey of physicians identified delays in receiving information and the lack of response to incidents as major obstacles. These frictions are not relational problems; they are process problems.
- Standardize the format of reports transmitted between professionals (the Saed also works between peers)
- Designate a communication referent for each complex patient pathway, responsible for verifying the consistency of the messages delivered
- Use a single secure messaging channel rather than multiplying supports (fax, mail, personal messaging, DMP)
When internal coordination is smooth, the patient perceives a unified message. They no longer need to act as a messenger between their various caregivers, a role that no one should impose on them.
Communication with patients does not improve through mere goodwill. It is structured with validated tools, measured with patient indicators, and adapted to the channel used. The practitioner who invests in these three dimensions sees tangible effects on adherence and satisfaction, without extending their consultations.