Communication Critical in Medical Care

We all know intuitively that communication is an important aspect of medical care.  Each of us can recall experiences where a doctor did a good or bad job communicating with us.  For me, the bad job was in the ER just before my mom was diagnosised with colon cancer when I was literally arguing with a doctor who wanted to send her home with antacids without doing any tests.  My ‘perseverence’ with that doctor resulted in a CT scan that showed the cancer. Boy was that an example of a doctor being unwilling to listen.  The good experience for me was the level of details received from my orthopaedic (Dr. Diefendorf) before, during, and after my rotator cuff repair surgery.  He told me what he was going to do every step of the way and then afterward showed me in pictures exactly what he had done.

Seems the medical community has gone from acknowledging the importance of communication in the abstract to practical implementation.   New applicants to medical schools are being asked to go through the Multiple Mini Interview (MMI) process, according to a recent New York Times article, “New for Aspiring Doctors, the People Skills Test.”  The applicants have two minutes to review a scenario of an ethical conundrum and then eight minutes to share how they would handle it. They then repeat the same process with more interviewers.   According to the article, “”We are trying to weed out the students who look great on paper but haven’t developed the people or communication skills we think are important”, said Dr. Stephen Workman, associate dean for admissions and administration at Virginia Tech Carillion.”

In an Atlantic Magazine article, “The Triumph of New Age Medicine” the medical community’s research and attitudes about alternative medicine is explored.  It is a long article with many interesting angles, but I narrowed in on the effects of communication in the equation.  The article outlines the commonality of many alternative medicine treatments; “These include a long initial meeting covering many details of the patient’s history; a calming atmosphere; an extensive discussion of how to improve diet and exercise; a strong focus on reducing everyday stress; an explanation of how the treatment will unleash the body’s ability to heal itself; assurance that over time the treatment will help both the problem that prompted the visit and also general health; gentle physical contact; and the establishment of frequent follow-up visits.”  Two aspects of this typical treatment scenario seem to make a difference 1) good provider/doctor-patient relationships  and 2) improvement of an overall healthy lifestyle.

Looking at the first aspect in more depth, communication is the core to the development of a good relationship.  According to the article, “A 2008 study on physician-patient relationships found that physicians deemed “exemplars” based on their reputation and awards received were likely to create an emotional bond with patients; to convey to patients that their commitment to caring for them will endure over time; and to imbue patients with “trust, hope, and a sense of being known.”

Good to know that what we all intuit is now being taken seriously by the medical community.  Yet, we still have a ways to go.  As the Atlantic article concluded,  “Every single physician I spoke with agreed: the current system makes it nearly impossible for most doctors to have the sort of relationship with patients that would best promote health. The biggest culprit, they say, is the way doctors are reimbursed. “Doctors are paid for providing treatments, not for spending time talking to patients,” says Victor Montori, an endocrinologist at the Mayo Clinic. A medical system that successfully guided patients toward healthier lifestyles would almost certainly see its cash flow diminish dramatically. “Last year, 75 percent of the $2.6 trillion the U.S. spent on health care was for treating chronic diseases that, to a large degree, can be prevented or reversed through lifestyle change,” says Dean Ornish of UCSF. Who (besides patients) has an incentive to make changes that would remove that money from the system?”

Of course, as patients we can influence change by demanding better communication from all our medical providers, and, when we have the option, voting with our pocket books for better provider relationships.