Intended for healthcare professionals

Career Focus

BEST: a communication model

BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7560.s35 (Published 22 July 2006) Cite this as: BMJ 2006;333:s35
  1. Romesh Gupta, consultant physician
  1. Lancashire Teaching Hospitals Foundation NHS Trust, Chorley

Abstract

We could all be better communicators. Rajeev Gupta and Romesh Gupta tell us about a model that's simply the BEST

The BEST model

  • Begin with non-verbal cues. Soften (smile, open arms, forward lean, touch with arm, handshake, eye contact, nod)

  • Establish information gathering with informal talk

  • Support with emotional channels

  • Terminate with positive note

RETURN TO TEXT

Changing patient expectations mean that effective communication is becoming increasingly important. Good communication skills are key to obtaining information, taking informed consent, and enabling patients and their relatives to be involved in management decisions. Well honed history taking skills can help you avoid unnecessary investigations and minimise patient discomfort.

Several models for improving communication in clinical settings have been proposed.12 All have merits, but there is a need for a simpler model that is easily remembered and readily applicable to daily practice.

The BEST model fills this void (box). It includes comprehensive verbal and non-verbal ways of communicating, along with emotional support. Showing empathy is important to facilitate any clinical interview; empathy increases efficacy and information gathering, and shows respect. Time spent listening helps clarify your patient's agenda and draws attention to their imminent needs. This in turn builds patient confidence.

Begin with non-verbals

Begin with non-verbal cues. Communication starts well before talking. For example, in clinic when you call a patient to your consulting room, there is non-verbal communication when you look at each other's faces and gestures.

Soften

Soften is a mnemonic for a series of non-verbal gestures that makes people more responsive and receptive to us.3 A smile indicates a friendly and open attitude. Smiling puts patients at ease and helps them feel comfortable in an environment that can be stressful.

An open body posture can convey a sense of being open minded and allows patients to feel they can reach you. Leaning forward slightly while talking shows your interest and encourages patients to talk. Take care not to get too close or invade personal space, though.

Eye contact is the strongest non-verbal gesture and indicates you are listening to what your patient, colleague, or relative has to say. Even when it's your turn to speak, you can continue to listen with your eyes. If you realise by your patient's facial expression that you have said something incorrect, correct yourself. Nodding shows you have listened carefully, and encourages the other person to keep talking.

More than two thirds of face to face conversation is based on body language. This is the aspect that often goes wrong, leaving patients unsatisfied.

It has been estimated that physicians interrupt patients within 23 seconds as they try to explain their problems. Be conscious of that.

Establish information gathering with informal talk

Information gathering is an art. Actively control, not by talking more or stopping conversation but by guiding conversations towards relevant topics, at the same time as interpreting symptoms.

Another good skill is to talk to patients while examining them. It often puts patients at ease, helping them to relax.

Support with emotional channels

There is a Chinese proverb—“words are just words and without heart they have no meaning.” Support your conversation with emotional channels, listen to the unsaid, share feelings, and transmit a message heart to heart, allowing non-verbal two way communication.

Empathy is important in any trusting relationship with patients. Your eyes, face, and gestures should all support you in demonstrating your continued interest in your patients. Keep nodding while the other person is talking, or when you are talking to emphasise important issues. Concentrate on what is being said and put your emotional energy into addressing patients' concerns.

In some cases, you may need to get past the tone of voice in order to listen effectively. Do not dismiss the patient if their tone portrays them as a complainer, as they may be angry or distressed. Before you do that, listen and make sure there are no legitimate issues you need to address.

Body language + tone of voice + words = total communication.

Terminate with positive note

Terminate conversations on a positive note. It's good to summarise briefly what you discussed and ask if there are any other concerns. If you have been listening carefully, you will be able to find at least a few relevant points that you can convert to positives. Try to instil hope.

Keeping these BEST steps in mind will help you do a swift consultation and maximise patient satisfaction. It's hard to consciously think of these initially but if practised for three weeks, a good proportion of these steps ought to infuse your practice.

Remember, effective communication has a positive impact on patients. They will feel more involved and empowered in their treatment. This also allows you to have greater job satisfaction, decreased complaints, and increased time efficiency, so follow the BEST model for the best results. ■

References