Both doctors and patients will benefit when exam room conversations go beyond the usual discourse.
Patients sometimes come to me and ask me to explain what a specialist told them. While I try my best to figure it out, I can't get inside another doctor's thought process. Thus, some of it is guessing on my part. Patients tell me the other doctor was too rushed and they didn't have time to ask questions, or the other doctor explained everything but they didn't really understand.
I tell my patients to be advocates for themselves, ask questions, and don't stop until they understand the answers. Yet, in an ideal medical setting, the information highway should not be a one-way street. It should be an open communication field with both parties on equal footing. Sadly, this rarely happens in healthcare. It starts from the time a patient makes the initial phone call to schedule an appointment and is left to navigate an endless phone tree to reach a living person. Upon entering the exam room, a patient is then relegated to becoming data points for the EHR.
The onus, however, is on the physician to make sure the communication with the patient is functioning. A patient is not going to follow a doctor's advice if they don't understand it or feel the provider does not have their best interests in mind. Part of a doctor's job is education patients and this cannot be done when we speak medical jargon. It won't work if we don’t make sure our patients understand what we are telling them. Giving misunderstood information is just as bad as giving a wrong medication.
How can we improve doctor-patient communications?
• Sit down. No one is going to believe you have an interest in what you are telling them when you breeze into the room, stand there above them, and speak down to them. Get down on their eye level and speak to them, not at them.
• Listen. One of the biggest complaints that I hear from patients is that the other doctor did not listen to them. If we listen, often patients will give us the answer. How can we address their worries when we don't know what they are?
• Address the patient on a personal level. I wonder how many doctors see a patient and don't know what they do for a living? With my pediatric patients, I always ask about school and any sports or other activities they may be doing. This helps make a real connection and people think you have a genuine interest in them as people and not just another task on the conveyor belt. It takes less than a minute. And you can't imagine the world of information you can stumble upon when you ask a patient, "How is work going?"
• Respond to messages. Some patients expect us to be at their beck and call 24/7. We are human and need down time. In our current healthcare environment, I think many of us are near the crash and burn point. But ignoring patient messages is a harbinger of disaster. Many patients tell me they called for days trying to get a question answered or an appointment scheduled. I just saw one patient with abdominal pain who tried to call her surgeon for days. Finally, she decided to see another surgeon. It is not just about losing patents. It is about medical care. What if this patient had a surgical emergency? We don't need to jump on the line whenever patients call. But, we should answer them in a reasonable time. Patients need to know that we will get back to them at our own time.
• Give the patient time to ask questions. Make sure they understand their diagnosis and treatment plan. You may have devised the perfect treatment plan but it is not going to work unless you get patients to buy into it.
Medicine, as well as the healthcare system in general, becomes more complex each day. Doctors need to be doing a better job educating patients and allowing them time to understand the complexities. Patients need to understand that doctors are being squeezed by external pressures like never before. Better communication will evolve only when both sides commit to making it happen.