Satisfactory and Effective Communication in Medical Care and Treatment

The medical humor in the last post virtually all point to the importance of and necessity for satisfactory and effective communication in medical care and treatment. As a member of a hospital ethics committee, I can attest to the fact that often what comes to the committee for resolution as an ethical conflict is not so much an ethical issue but a problem in communication between a physician and a patient or family or between physicians themselves or with their hospital nursing staffs.

In an outpatient setting, the study by Keating, Nancy L. MD, MPH; Green, Diane C. PhD, MPH; Kao, Audiey C. MD, PhD; Gazmararian, Julie A. PhD, MPH; Wu, Vivian Y. OTR, MS; Cleary, Paul D. PhD "How Are Patients' Specific Ambulatory Care Experiences Related to Trust, Satisfaction, and Considering Changing Physicians?" in the Journal of General Internal Medicine V.17, Nr. 1 pages 29-39, Jan 2002 statistically confirms the need for better doctor-patient communication.

The objective of the study was "To assess the relationships between outpatient problem experiences and patients' trust in their physicians, ratings of their physicians, and consideration of changing physicians. We classified as problem experiences patients' reports that their physician does not always 1) give them enough time to explain the reason for the visit, 2) give answers to questions that are understandable, 3) take enough time to answer questions, 4) ask about how their family or living situation affects their health, 5) give as much medical information as they want, or 6) involve them in decisions as much as they want." 2052 patients were contacted in a 1999 telephone survey. "Most patients (78%) reported at least 1 problem experience. Each problem experience was independently associated with lower trust and 5 of 6 with lower overall ratings. Three problem experiences were independently related to considering changing physicians: physicians not always giving answers to questions that are understandable,not always taking enough time to answer questions, and not always giving enough medical information."

In conclusion the authors state "Although most patients' experiences with their physicians are good, those that are not may have important consequences, including lower trust, lower ratings of physicians, and greater likelihood of changing physicians. More physician training in communication skills, particularly focused on answering questions in ways that patients can understand, taking enough time to answer questions, providing adequate amounts of information, and discussing differences in opinion about whether tests, procedures, or referrals are needed, may strengthen patient-physician relationships. This type of training is effective and should be a priority of residency training programs, medical schools, medical groups, and health care organizations."

Interestingly, though the importance of good communication is stressed in the business world and efforts are taken to improve communication skills with specific courses and consultations and there is some effort in medical school education to teach proper communication skills, virtually none is taught when the physician is in practice. There is a need for the medical community to show as much interest in improving medical communication as it does for improving diagnosis, medical drugs and treatments. ..Maurice.