HOW TO Improve Doctor-Patient Communication

According to recent surveys, the average American spends about of 15 minutes with their doctor per visit.  Then during the visit, when you try to explain what's troubling you, the doctor normally interrupts within a few seconds.  Now, there are so many doctors who have become tired of this situation, they have either left medicine altogether, or started a new way to provide patient services: the pay-in advance system, also know as “Concierge Medicine.”  So now you can get your doctor to pay attention to what you are saying, but you have to pay him more in order to do it.  Funny, I thought that is what we had health insurance for in the first place.  The Hippocratic Oath that all doctors must take does not specifically require input from the patient, but I have yet to meet a doctor who is omniscient.

This situation must be managed better for the benefit of the patients in today’s medical world. This is your life, not an assembly line, and the drugs you see advertised on TV will not solve all of your problems.  The same Institute of Medicine report that showed as many as 98,000 deaths occur annually because of medical errors also identified poor doctor-patient communication as one of the root causes along with inadequate treatment monitoring and follow-up.¹  In addition, a recent study sponsored by the Agency for Healthcare Research and Quality (AHRQ) found that physicians aren't doing enough to help their patients make informed decisions.²

"There is a lot of disaffection with modern medicine," says Dr. David Katz, cofounder and director of the Yale Prevention Research Center.  "Patients are unhappy that doctors in the past haven't taken the time to explain things, so the next time they see a doctor they come in annoyed, which makes the physician even less willing to talk."

Other studies show that strong patient-doctor communication is a key to patient satisfaction, faster healing time and adherence to medical recommendations.  It has been proven over and over again that people with a wide variety of illnesses heal faster when doctors and patients take the time to both talk with and listen to each other. 

Last year, the University of the Pittsburgh School of Medicine opened the Institute for Doctor-Patient Communication. The director of the new institute is Dr. Robert M. Arnold.  "Nationally, there is relatively little research being done on doctor-patient communication and how we can evaluate what physicians are doing when they talk to patients," Dr. Arnold said. "There has been lots of research on patient satisfaction, but very few people look under the hood, so to speak, and say, 'What is the relationship between what the doctors say and what patients hear?"

So no matter what doctors do, if you know that clear communication and understanding is critical to your good health and well-being, then there are some important things you should do on every visit to the doctor.

1. Create Notes or a Script for Your Visit and Take It with You

ICOE strongly recommends the use of the ReadyLifeline™ book to record your notes, visit and treatment summaries, and key personal medical facts.  This will help you to reference and present accurate information during your visit.

Use your ReadyLifeline™ and notes to plan what you want to say to the doctor ahead of time. The more specific the details you can provide, the better. Bernice Avalos who suffers from heart and diabetes ailments, notes that telling your doctor, "I get out of breath every time I walk outside," is not as useful as saying, "Until two months ago I could walk around easily, and now I get out of breath just getting out of bed."

But there is a catch…You might think that doctors would be delighted when presented with a list of problems, but that may not be the case. In an article published by the Minnesota Medical Association in February 1998/Volume 81 listing the top 10 things that drive doctors crazy, patients with lists of symptoms or questions ranks at number 2.  So how can you handle this situation?  Write down your questions and concerns, review them in the waiting room so you can discuss them with the doctor, but keep the list in your ReadyLifeline™ for reference during the course of the visit - especially when seeing a doctor for the first time.

2. Get Copies Of Your Medical Records.

It is your right to receive copies of your medical records. Getting acquainted with them will help you to become more informed, and more capable of helping to manage your care and treatments.  Examples of records to have in your possession are your latest EKG, X-Rays, Cat-Scans, MRIs, medication details and so on.

 

3. Use the Internet, but Use it as an Educational Tool.

It is always helpful to educate yourself about the illness or symptoms that you are experiencing.  This may help you to not only select the right type of doctor to see, but also in asking the most appropriate questions that will get you the information or treatment you are looking for.  Your questions may also jog the doctor's memory or prompt him or her to look for more information or consult with another physician to get you the most appropriate treatment.

 

The July 2004 issue of the Harvard Health Letter recommends that “Despite the wealth of misinformation on the Internet, there is also plenty of credible health information to tap into it. Some quality resources include www.intelihealth.com and www.nih.gov.”

 

Keep an open mind about things you read, and do not take anything you read as the last word. Remember, everyone, including doctors and the internet, has their own opinion.  When it is your life at stake, more than one opinion is not only prudent, but often necessary. One way to do this is to reference www.healthfinder.gov that lists websites that have been reviewed by the U.S. Department of Health and Human Services.

4. Bring Up The Most Important Things First.

People will often have a problem they really want to discuss, but that they are nervous or embarrassed about.  As the result, they have to work up some courage to bring it up, and that is often at the end of the visit.  If your 15 minutes is over, that probably will make the discussion rushed, and leave you feeling dissatisfied, says Dr. Robert Arnold, director of the Institute for Doctor-Patient Communication. Instead, make a point to bring up the problem at the beginning of the examination.

5. Be Assertive About What You Want  - but Not Demanding.

In a study published in the Archives of Internal Medicine, 559 patient visits to 45 different doctors in two different healthcare systems were audio-taped. The results showed that patients requesting specialty referrals or medications were far more likely to receive them than those who waited for the doctor to recommend something on his own.  At the same time, respect the doctor’s opinion when he/she doesn't want to give you a medication or perform a test or treatment - as long as the doctor provides concrete and logical reasons for the recommendation.  If the doctor feels affronted simply because you questioned his or her opinion, then, in the words of the Harvard Health Letter, “If you find your doctor too bossy or too deferential, make that known. If it continues to bother you, think about switching doctors.”

6. Don’t Be Afraid To Ask Questions.

We all know that in everyday life, it is easy to misunderstand something and go in a completely wrong direction.  This happens to me just ordering fast food.  In medicine, this can happen just as easily.

 

We normally assume that patients and doctors speak the same language.  But just think about how many weird medication names, abbreviations and acronyms a doctor or nurse can use.  My roommate in college had to study Latin to become a pre-med student.  I, on the other hand, struggled just to make my english intelligible.  That is why it is important to ask your doctor to spell things out and for you, and for you not to be embarrassed to ask if you don't understand.  It makes everyone's life easier in the long run and avoids a host of potential problems.  On the other side of the coin, if your Doctor asks you what you mean by something, don't be upset; just spell it out as best you can.

 

Many patients feel the stress of time-crunched medical professionals, and leave the doctor’s office without quite knowing what they were told.  The American Institute for Preventative Medicine advises that if medical terms confuse you, ask for simple definitions.  Repeat what the doctor has told you in your own words.  Use simple phrasing like, “What I heard you say was this…” or “My understanding of the problem is…ICOE also recommends that you write down the results of the visit in your ReadyLifeline™, and have the doctor or nurse review it for accuracy.  That way, you not only have a record of what occurred, but you don’t have to just rely on your memory.  You might also consider bringing along a spouse or friend to serve as another set of ears or to take notes for you.

 

Finally, if the doctor gives you a prescription for treatment or medication, make sure that you can read it.  The chances are that if you cannot make it out, neither can your caregiver, pharmacist or nurse.  Many of the medical mistakes that occur every year are due to misunderstood writings and instructions.  For medications, always make sure that you understand the name of the medication, the dosage and the dosage frequency.  This will prevent misunderstandings and sometimes annoying clarification delays.

7. Give Your Doctor As Much Information As You Can

Around 80% of the information your doctor needs to make a correct diagnosis comes from what you say to him or her. The rest comes form examinations or test performed.

 

This verbal information comes from two sources: what your doctor asks you, and what you say without being asked.  So, don’t be afraid to tell your doctor exactly what you are feeling or what has happened to you - anything can be helpful in diagnosing and remedying your problem. 

 

The ReadyLifeline™ gives you the vehicle to record and then recall many of these informational details.  If there is anything you think your doctor needs to know, for example, that you are taking herbs, or supplements, or over-the-counter medications purchased from the drugstore, then say so.  This type of information should be included in your history file because it may affect either current or future treatment (for example, certain herbs interact badly with some prescription medicines).  If the doctor disagrees with what you are taking or doing, then listen.  After all, they are the doctor.

Good doctor-patient communication is a two-way street.  However, in today’s medical care system, it often falls to the patient to take some or much of the responsibility for helping to manage his or her own healthcare.  Armed with this knowledge, you need to get involved and help to make things happen.  ReadyLifeline™ can be a key tool in your arsenal of weapons to help you fight for your medical rights and personal health.

1.    Institute of Medicine. To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press; 2000.

2.    Boutin-Foster C, Charlson ME. Problematic resident-patient relationships. J Gen Intern Med. 2001 Nov;16(11):750-4.

 

How To Improve Doctor-Patient Communication