Wilberg on Wednesday - The Illness Is The Cure pt 42/46

Appendix 5. From ‘Doctor-Patient Communication:

A Review’

Jennifer Fong Ha, MBBS (Hons) Dip Surg Anat and Nancy Longnecker, PhD, The Ochsner Journal, Ochsner Clinic Foundation, Spring 2010

“The patient will never care how much you know, until they know how much you care.”

Terry Canale in his American Academy of Orthopaedic Surgeons Vice Presidential Address

Much patient dissatisfaction and many complaints are due to breakdown in the doctor-patient relationship. However, many doctors tend to overestimate their ability in communication.

Basic communication skills in isolation are insufficient to create and sustain a successful therapeutic doctor-patient relationship, which consists of shared perceptions and feelings regarding the nature of the problem, goals of treatment, and psychosocial support.

Studies on doctor-patient communication have demonstrated patient discontent even when many doctors considered the communication adequate or even excellent. Doctors tend to overestimate their abilities in communication. Tongue et al reported that 75% of the orthopedic surgeons surveyed believed that they communicated satisfactorily with their patients, but only 21% of the patients reported satisfactory communication with their doctors. Patient surveys have consistently shown that they want better communication with their doctors.

A more patient-centered encounter results in better patient as well as doctor satisfaction. Satisfied patients are less likely to lodge formal complaints or initiate malpractice complaints. Satisfied patients are advantageous for doctors in terms of greater job satisfaction, less work-related stress, and reduced burnout.

It has been observed that communication skills tend to decline as medical students progress through their medical education, and over time doctors in training tend to lose their focus on holistic patient care. Furthermore, the emotional and physical brutality of medical training, particularly during internship and residency, suppresses empathy, substitutes techniques and procedures for talk, and may even result in derision of patients.

Good communication skills practiced by doctors allowed patients to perceive themselves as a full participant during discussions relating to their health. This subjective experience that influences patient biology is the “biology of self-confidence” described by Sobel, which emphasized the critical role of patients' perception in their healing process.

There are reported observations of doctors avoiding discussion of the emotional and social impact of patients' problems because it distressed them when they could not handle these issues or they did not have the time to do so adequately. This situation negatively affected doctors emotionally and tended to increase patients' distress. This avoidance behavior may result in patients being unwilling to disclose problems, which could delay and adversely impact their recovery.

Physicians have been found to discourage patients from voicing their concerns and expectations as well as requests for more information. This negative influence of the doctors' behavior and the resultant nature of the doctor-patient communication deterred patients from asserting their need for information and explanations. Patients can feel disempowered and may be unable to achieve their health goals. Lack of sufficient explanation results in poor patient understanding, and a lack of consensus between doctor and patient may lead to therapeutic failure.

Today, patients have recognized that they are not passive recipients and are able to resist the power and expert authority that society grants doctors. They can implicitly and explicitly resist the monologue of information transfer from doctors by actively reconstructing expert information to assert their own perspectives, integrate with their knowledge of their own bodies and experiences, as well as the social realities of their lives. Being attentive to social relationships and contexts will ensure that this information is received, and most importantly, acted on.

…inequality, social relations, and structural constraints may be the most influential factors in health care.

Attentive listening skills, empathy, and use of open-ended questions are some examples of skillful communication.

Important factors include understanding patients' perspectives, sharing information, and patients' knowledge and expectations. Miscommunication has serious implications, as it may hinder patients' understanding, expectations of treatment, or involvement in treatment planning. In addition, miscommunication decreases patient satisfaction with medical care, level of hopefulness, and subsequent psychological adjustment.

…patients often regard their doctors as one of their most important sources of psychological support. Empathy is one of the most powerful ways of providing this support to reduce patients' feelings of isolation and validating their feelings or thoughts as normal and to be expected.

In addition to minimizing avoidance behavior, which prevents patients from expressing opinions, effective doctor-patient communication should involve productive conversation, which involves understanding of both parties' perspectives, by shifting from a perspective that is rigidly certain of one's belief to a more exploratory approach that strives to understand the situation from another perspective.

Good doctor-patient communication is a mechanism used to gain an understanding of patients' social context, expectations, and experience.

Doctor-patient communication is a major component of the process of health care. Doctors are in a unique position of respect and power. Hippocrates suggested that doctors may influence patients' health.