Physician-patient Communication Makes News

July 30, 2010

News of a sort, that is.  Health Affairs, the top health policy journal, gives rare attention to the subject in its July issue.  The news is two-fold:

  • More than ever, the health policy establishment is recognizing that effective physician-patient communication is essential to high-quality care.
  • And, researchers are saying that physicians need intensive communications training in order to interact successfully with patients.

The Health Affairs article focuses on the physician side of communication, while our blog focuses on the patient side.  We patients benefit, though, from knowing what the researchers are telling physicians.  Then, we can develop appropriate expectations for our doctors’ conversations with us.  So, read on.

sign saying "The Power of Conversation"The three authors of the article are Canadian Wendy Levinson, internal medicine executive Cara Lesser, and Ronald Epstein MD, director of the Rochester Center to Improve Communication in Health Care.   They note that physician-patient communication is a “sophisticated process”–not just a hodgepodge of feel-good platitudes.  For example, it’s linked to better outcomes of care for patients with diabetes, hypertension, and cancer.

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The Conversation No One Wants–and Everyone Needs

July 29, 2010

As some of you point out, the August 2 New Yorker includes a long article by Atul Gawande on problems in end-of-life care.  The core problem is the lack of realistic conversation between physicians and patients about what the patient wants.

Most surprising to me in the article was the admission by Gawande–a leading general surgeon, medical commentator, and advocate of the use of life-saving checklists for surgical procedures–that he only recently learned what hospice care really entails.  Tragically, most physicians, patients, and families turn to hospice only in the patient’s final days or even hours.  Patients then miss out on hospice’s full range of:

  • comfort care
  • social supports
  • extraordinary nursing coverage
  • pain management
  • respite care for family members–and
  • the chance to talk about concerns and ongoing changes.

Hospice patients live as long or longer than their counterparts receiving more invasive services–such as the tubes, ventilator care, painful and futile procedures, and indignities in the usual course of treatment for patients with terminal diseases.

Hospital Patient

Patient Alone in Hospital

In 1982, the very early days of Medicare reimbursement for hospice, my mother-in-law moved into our home and enrolled in hospice.  The hospice professionals’ responsiveness, knowledge, and compassion turned a horrible experience into an enriching one.  Later my wife Vicki led the Robert Wood Johnson Foundation’s brilliant “Last Acts” campaign to improve end-of-life care, and I worked with a national hospice provider on communication issues.   Our interest is reflected in my book in Section 6, “Making a Living Will and Proxy.”

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Doctors Sharing Notes with Patients

July 27, 2010

After a visit to the doctor, would you like to see his or her notes about the visit?

Looking at the doctor’s own notes might give you a much more informed perspective on your health status.  For example, you might then understand why the doctor asked you certain questions, or you might learn how your health may be changing.  But, seeing the doctor’s notes also might confuse you, worry you, or  needlessly anger you:

  • confuse you, because doctors of course use highly technical terms that most of us don’t understand, and their notes assume a working knowledge of medical concepts
  • worry you, because the doctor might mention the possibility of scary diseases or conditions, which you almost certainly don’t have, and
  • anger you, because you may react to abbreviations or terms that mean something very different from what you think they mean.

photo of physician and TB patient from 1927

A new demonstration project, called OpenNotes, is examining how patient access to doctors’ notes will affect health in three communities.  Although barely begun, the project already has received attention in the Wall Street Journal and in a highly respected medical journal, the Annals of Internal Medicine.

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Health Reform Coverage Is Up to the States

July 26, 2010

Concerned about the impact of health reform on your health care?  To a large extent, insurance coverage under the new law will depend on actions taken by state governments.  Here’s a quick rundown—and a suggestion.

The reform law passed by Congress in March 2010—known as the Patient Protection and Affordable Care Act—gives a huge role to states.  State governments are empowered to create health insurance “exchanges,” which will cover those individuals and small businesses not covered through the private insurance market, Medicare, or Medicaid.  The law lets states shape most aspects of this exchange-based coverage.

photo of legislator

Under the new law, states also can:

  • run “high-risk pools” for people who now can’t get coverage
  • expand Medicaid to include people with incomes substantially above the poverty level
  • regulate private insurance plans, including premium rates
  • develop strategic plans to focus on key issues, such as obesity or disease prevention.

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Know the Doctor’s Office Staff

July 26, 2010

At a doctor’s office that I visit frequently, I’m usually waved in without registering, seldom have to wait, and feel like an old friend.  Why?  The front desk staff knows me.

image of receptionist

Using simple communication skills, a patient—you!—can transform a doctor’s office from a cold, sterile place into a welcoming, helpful environment.  One way is to focus on the office staff.

Larrie Pittelko is a registered nurse in Minnesota with extensive experience in physician-patient communication.

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What This Blog is About

July 19, 2010
Patients often suffer from a lack of effective communication with their physicians and other health care providers.  Many people blame physicians for this common and important problem, citing doctors’ poor communication skills.

But communication is always a two-way street.  Patients and their families can greatly improve their interactions with the health care system by using good communication skills themselves.  And, it’s surprisingly easy to do this.

This blog—and our practical guide, “Make the Health Care System Work for You!”—are dedicated to helping patients communicate successfully with doctors, other health care providers, and the health care system in general.

We welcome your own ideas and your experiences, good and bad!  Please share them with us.  (If you like, we’ll be happy to protect your confidentiality.)

Thank you and take care,

Neil Weisfeld