Good Doc-Patient Communication Vital & All Too Rare
In a recent review of studies, researchers found that good doctor-patient communication leads not only to happier patients, but also to better health. Unfortunately, other research indicates that “good” doctor-patient communication may be in short supply. It turns out that many physicians spend too much time talking about themselves and their personal lives while seeing patients, and too little focusing on the patients’ issues. No doubt this is well-meaning, intended to make a connection and put people at ease — but investigators found it most often to be a waste of time.
I called study author Susan H. McDaniel, PhD, a professor of psychiatry and family medicine at the University of Rochester Medical Center in New York to learn more about the study and see what advice she might have for patients of chatty doctors. Researchers were surprised at the results of their study, she told me. It revealed that physicians interjected personal information about themselves in one of every three primary care visits, while an earlier study had revealed this behavior in less than one in five visits. But either way it’s common, Dr. McDaniel said — too common.
WHEN PHYSICIANS TALK A LOT
The University of Rochester study involved 113 unannounced, undetected, standardized visits to primary care physicians in upstate New York. The doctors had agreed to permit actors trained to behave like patients to visit them twice over the course of one year and make secret recordings of the visits. The researchers then studied the transcripts, specifically looking at how much doctors talked about themselves, what they said and whether it was of any value to patients. Visits where the doctors figured out that the patients were actors were not included.
Dr. McDaniel and her colleagues found that…
- Doctors talked about themselves in 38 (34%) new patient visits — most often when taking a patient’s medical history, but also throughout the interview.
- The vast majority of personal discussions (62, or 85%) were not considered useful to the patient.
- Only 29 (21%) of those doctors even returned to the patient topic that preceded their self-disclosures.
- Eight (11%) physician disclosures were considered to be actually disruptive, meaning they detracted from the physician-patient relationship (e.g., when the doctor expressed personal or political opinions that failed to take the patient’s perspective into account). Some of these even appeared, unwittingly, to compete with the patient or in some way put the patient down.
- Only three (4%) were deemed useful to patients. In all three instances, physicians disclosed that they had the same medical condition as the patient and were therefore able to provide helpful support and information.
In general, the longer doctors went on about themselves, the less useful the conversations were. These results were published in the June 25, 2007, issue of the Archives of Internal Medicine.
ENHANCED COMMUNICATION LEADS TO ENHANCED HEALTH
Interestingly, this study follows research earlier this year that highlighted the critical importance of effective doctor-patient communication. Generally, that includes communication that is patient-focused, uses good listening skills, sets a mutually agreed upon agenda and makes sure the patient understands and agrees with the treatment plan. At the Indiana University School of Medicine, a review of 36 studies suggested that good communication resulted in measurable improvements such as…
- Lower blood sugar in people with diabetes.
- Resolution of chronic headaches.
- Improved blood pressure in people with hypertension.
- Positive changes in emotional states.
This research was published in the April 2007 issue of Medical Care, a journal of the American Public Health Association.
STAY ON TRACK AND ASK QUESTIONS
So, there we have it… good doctor-patient communication is good health care, perhaps even saving some lives — but all too often the doctor gets in his/her own way. In order to make visits as productive as possible, doctors should listen to patients more and ask them if they have any questions about the information discussed, says Dr. McDaniel. They should also practice using empathy rather than personal anecdotes to connect with and understand patients.
But since there’s no guarantee any of those things will happen at your doctor’s office, the onus is on you as a consumer to take responsibility for your own health. A good way to get the most out of a visit, says Dr. McDaniel, is to begin the appointment by voicing your two (or at most three) most important concerns so your doctor will know what needs to be covered. It is then easier to redirect the conversation if it veers off-course. For example, when the doctor starts talking about a recent trip to France, she suggests that you gently interrupt, saying something like: “I know you have limited time, and I just want to make sure we address the issue of my toe.”
As always, it’s important to speak up and ask questions so you fully understand your condition and your doctor’s advice on treatment. Consider bringing along a written list of your questions so nothing gets overlooked. It also helps to take a friend or family member to appointments with you, especially when you are dealing with serious medical issues. “This not only provides another person to reflect on the patient’s concerns,” says Dr. McDaniel, “but especially another person to remember what the doctor said.” Referring, of course, to what the physician said about your health — not about the food in Paris.
Source: Susan H. McDaniel, PhD, associate chair, department of family medicine, professor of psychiatry and family medicine, director, Institute for the Family, and the Wynne Center for Family Research in Psychiatry, University of Rochester Medical Center, Rochester, New York.