|
|
 |
 |
HOT TOPICS - DOCTOR AND PATIENT COMMUNICATION
"Medical care is a conversation. So to have influence in that conversation you have to speak up."
-Director of the Program in Health Communication and Decision Making in the Houston Center for Quality of Care and Utilization Studies at the Baylor College of Medicine.
Doctor and Patient, Now at Odds
By Tara Parker-Pope
A growing chorus suggests that the once-revered doctor-patient relationship is on the rocks. more...
Boston Globe
Identical Care Isn't Best for All Patients
Current standards of care encourage doctors to check boxes on forms rather than tune into the needs of their patients. more...
 A
Dialogue with Cancer:
Communication between
Doctors and Patients
Communication is
difficult under the
best of circumstances,
but when you are diagnosed
with cancer, this can
be an even more challenging
task. By improving
communication between
doctors and patients,
we can develop a relationship
based on trust and
compassion. This DVD
profiles cancer patients
and their doctors as
they navigate through
diagnosis, treatment
and recovery. Together,
they engage in a dialogue
that promotes understanding,
identifies barriers
and encourages change.
Watch a Preview
$40.00
MAKE THE MOST OF YOUR NEXT DOCTOR'S VISIT
Before you go...
- When making the appointment, state the nature of your concern so that a proper length of time can be scheduled.
- If it is your first visit to a particular clinic or physician, be ready to provide information about diseases that run in your family and describe current and past health problems and treatments. Write it all down if that helps.
- Make a list of medications you are taking including the doses and frequency of prescription and over-the-counter drugs, as well as herbs, supplements and vitamins.
While you are there...
- Your health is worth the physician’s time. Restate explanations and ask for clarification.
- Share the list of medications that you made.
- Don't forget about your emotional health; it influences your physical health.
- Try to reach an agreement about the recommended treatment plan.
Before Leaving...
- Find out if and when you should return for another visit.
- Ask if you need to watch for certain warning signs for your condition, ask when you should be concerned and at what point you need to call in.
- Get backdoor contact information. What’s the best way to reach the doctor if you have questions or concerns – by email? phone? What hours are best? How soon can you expect a response?
- Never leave uncertain about your diagnosis or treatment plan.
- Source: Adapted from the Allina Hospitals and Clinics Website.
HOW
COMMUNICATION AFFECTS
HEALTH OUTCOMES:
- Clinician gathers information from patient
- Clinician and patient discuss care management plan
- Clinician provides emotional support
- Clinician and patient share in making treatment-related decisions
WHAT
THE RESEARCH TELLS US:
- A patient's participation in discussing treatment alternatives leads to treatment decisions that best meet the patient's needs and preferences.
- When a clinician and patient share understanding about the patient's health situation and decide on a mutually agreeable treatment approach, compliance is likely to be high, and health outcomes improve.
- A clinician-patient relationship built on good communication and on trust established over time--a situation typical of many cancer care encounters--is associated with better health screening behavior and more effective delivery of health care services.
TALKING THE TALK:
Improving Patient/Provider Communications
The Issue:
Today’s patient often has to overcome a number of hurdles — poor access to primary and specialist health care, high costs and bureaucratic gatekeepers — just to make it into the physician’s office. Once there, another obstacle can loom large: Will patient and health care provider have a meaningful dialogue about the patient’s health, or will it be a consultation of misunderstanding and mistrust?
The Facts:
- Healthy People 2010 defines health literacy as “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.”
- The Institute for Healthcare Advancement estimates that the average annual health care costs of people with very low literacy may be four times greater than the general population’s.
- Low health literacy is particularly common among older adults and low-income patients. More than 66 percent of U.S. adults age 60 and older have inadequate or marginal literacy skills, and about 45 percent of all functionally illiterate adults live in poverty.
- Racial and ethnic differences can contribute to communication breakdowns. As many as 20 percent of Spanish-speaking Latinos say they do not seek medical advice due to language barriers.
- Lack of diversity among health care providers can be a barrier to culturally competent communication. Minorities make up 28 percent of the U.S. population but only 3 percent of medical school faculty, 16 percent of public health school faculty and 17 percent of all city and county health officers.
- Female primary care physicians tend to engage in longer visits and have more “patient-centered” consultations than their male colleagues do.
INTERVIEW:
Doctor, Explain Thyself: Putting the Burden of Communication on the Provider with Dean Schillinger, M.D.
Dean Schillinger, M.D. is an assistant clinical professor of medicine at University of California, San Francisco, and San Francisco General Hospital. His interests include improving health care for diverse and vulnerable populations cared for in safety-net institutions. In particular, his work has focused on the impact of primary care for vulnerable patients with chronic conditions, the provider-patient relationship, domestic violence, language barriers and health literacy.
Q/ What sort of specific techniques for improving physician-patient communication are you studying?
A/ The techniques we are looking at now are about different ways of creating an environment that is nonthreatening, thinking of ways that we can make the milieu more safe and comfortable. We want it to become less unidirectional and more of a partnership.
Q/ Are there specific communication techniques aimed at particular ethnic or cultural groups, or disease groups?
A/ There is of course a recent IOM report, Unequal Treatment Confronting Racial and Ethnic Disparities in Health Care, that addresses some of that. But for all people, there are two fundamental dimensions we need to attend to. The first is speak clearly and be an attentive listener. The second is express that you care. Empathy goes a long way in building trust and setting up a relationship so that communication is successful. With regard to minority populations specifically, increasing the workforce to include individuals from the same community and increasing language access has got to be more of a priority than it currently is.
Q/ What role can technology and multimedia play in patient-physician communications?
A/ With regard to chronic diseases, the need for ongoing communication is high, and this is one place where technology can help. We have done some work with automated telephone advice, and we quickly realized that we needed to change our style to become more narrative, to use something like, “If you want to hear how Mrs. Jimenez dealt with her depression, press 1.”
But people get caught up in technology and forget to make it accessible. We need to focus on using basic words and making the message clear. There was a study done at a VA hospital that employed CD-ROM-based information for prostate cancer treatments. It’s very hard in a brief clinical encounter to cover all the complex information needed to make a decision about that. So patients watched the CD-ROM a half-hour before meeting with their doctor, and lo and behold, the CD-ROM was associated with greater satisfaction among the overall population of patients. But when they surveyed those patients, they found that those with a lower level of literacy still had no greater knowledge about their condition.
Q/ What do patients say is the biggest barrier to understanding their physicians?
A/ I hear two things again and again: First, my doctor is asking me to do all these things, but she or he doesn’t understand the challenges in my day. And they’re not always talking about challenges like child care or a dying grandmother, although those are certainly part of it. They are really asking, where’s the opportunity for me to respond and give a “reality check” to these things that you’re asking me to do? They’re asking doctors to help them prioritize, to help them solve their problems in a true partnership.
The second thing reveals that we’re not being clear with our patients. Patients say “my doctor needs to break it down for me — what am I supposed to do? He says I’m supposed to eat a more nutritious diet, but how do I do that?”
Q/ When physicians and patients don’t communicate well, what is the risk? Are patients just not receiving the best possible care or are they actually putting themselves in immediate danger?
A/ In rare instances, communication breakdown in the walk-in setting can absolutely lead to serious errors. There are breakdowns that can lead to fatal or life-threatening problems, such as when a patient doesn’t understand about a dosage, or doubles up on medications that have different brand or generic names.
Much more common, however, are breakdowns of communication that lead to poor quality of care over the long haul. Patients who experience these breakdowns may be raising their risk of having disease complications compared to other patients.
Q/ Is it the patient or the physician who is most in need of better communication techniques?
A/ It takes two to tango — a good dance requires a good leader and a good follower to keep the dance going. The problem we get into in medicine, especially with a power dynamic of lower-literacy people versus those with advanced literacy, is that it’s very unidirectional. Doctors need to be more explicit in eliciting a patient’s understanding, and actually activating patients to respond. Patients need to come into visits more prepared to do that.
Q/ What’s your sense of how physicians and patients view these communication breakdowns?
A/ There has definitely been shared frustration over the last few decades, much of it projected onto managed care systems. While it may be appropriate, because these systems often do not support continuity and trust, I think we need to look within as well. Looking into the future, I hope that the frustration that patients and providers feel could be put to use productively.
If there could be a day when a patient can come into a room and say, “You know, doc, I appreciate all you’ve done for me, but I was kind of offended when you said this and that,” and a doctor can say, “Well, you’ve done really well taking care of your condition. But I think I said that because I felt that you should take more responsibility for these other parts of your disease,” then we would have a real relationship. We would have two people working on the same problem, dissecting why things are working the way they are, and trying to fix them. That would be wonderful.
Q/ How has your work on physician-patient communication affected your own practice?
A/ It’s remarkable to me that there are so many problems that go by that are completely invisible.
The mistake we make is that we assume patients are telling us everything, and that we are being clear to our patients, which is clearly not the case. We assume that there’s no veil to pull away, when clearly there are multiple layers of veils.
ONLINE RESOURCES
For more information on physician-patient communication and health literacy:
HELPFUL ARTICLES
NY Times
The
Importance of Knowing
What the Doctor Is Talking
About By Jane E. Brody 
NY Times
The
Doctor Will See You for
Exactly Seven Minutes By Peter Salgo
National Institutes of Health (NIH)
Talking With Your Doctor
BACK TO TOP |
|
