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.
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.
The National Cancer Institute–an excellent resource for communication issues facing cancer patients–says that physician-patient communication performs six functions:
- fosters healing relationships
- exchanges information
- responds to patients’ emotions
- manages uncertainty
- makes informed decisions, and
- enables patients’ self-management of their care.
Yet, communication skills are nearly ignored in medical education, especially in training residents (you know, the young doctors in TV shows set in what are supposed to be hospitals). It’s easy for medical educators to dismiss communication as “not scientific” or “a frill,” when they know little about it.
Fortunately, the tide appears to be turning. The American Board of Medical Specialties, which oversees board-certification of MDs in all specialties, is moving toward testing physicians’ communications skills as part of recertification. That’s important, because physicians seek recertification during their careers in order to stay board-certified, as hospitals and insurers want them to be.
Levinson, Lesser, and Epstein summarize a review of 36 studies of physician-patient communication. The studies support the idea that “high-intensity interventions”–those that involve multiple education methods, take place over several training sessions, and use live instructors–work better than more casual efforts. (You’re thinking, “Duh.”)
So, let’s expect our doctors to know enough to ask us a lot of questions about what we’re feeling, what our priorities are, and what we want from a particular episode of health care. If the doctor doesn’t ask you these things, doesn’t listen attentively to your answers (and write something down), or doesn’t ask follow-up questions, say: “Aren’t you interested in what’s important to me about this?”
That could lead to an interesting–if brief–conversation. And who knows but the doctor might communicate better with you next time. Revolutions start with small steps.