Communication vital for patient-physician ties
Victoria Simms

GOOD medical care is the result of a partnership between the patient and the doctor, and a true partnership is based on effective communication. A recent survey by the Bayer Institute for Health Care Communication (that operates as a non-profit organisation in Canada and the USA) proves that communication plays a pivotal role in the physician-patient relationship, with patients overwhelmingly agreeing that communication affects their perception of the quality of care they receive to a great extent.

However, the survey also shows that patients and physicians differ significantly on what defines good communication. Patients believe good communication is an interactive discussion with their physicians, one in which the physician understands the patient and both parties ask questions and share answers about the patient’s overall health. In contrast, physicians define good communication more narrowly: for example, having the ability to explain medical problems and treatment options in easy-to-understand language.

Because recognising differences in how physicians and patients view communication can be important to a patient’s perception of his or her medical care, here’s what patients can do to enhance communication with their doctor:

• Be prepared. Be ready to clearly discuss all symptoms and any significant changes. Write down questions and concerns. If medication is prescribed, has it been taken consistently? This information will help the physician interpret the patient’s condition and make the most appropriate medical decisions regarding the patient’s health.

• Be honest. If the patient wants to develop an effective relationship with his or her physician, the patient must share any information that the doctor needs to successfully evaluate and treat the problem. Some topics may be difficult or embarrassing to discuss, but a doctor who is sensitive to a patient’s needs, will try to make any discussion as comfortable as possible. If the patient is still embarrassed, it may help to preface the conversation with, "It’s not easy for me to talk about this."

• Watch body language. Patients should be careful about what they tend to assume from the doctor’s nonverbal cues. For example, lack of eye contact can be off-putting for patients, but when a physician is taking time to look at a chart, it may be part of an effort to explain the patient’s medical condition to him or her as fully as possible. However, to avoid dividing the physician’s attention, the patient may want to wait until the physician has finished reviewing the chart before continuing to speak.

• Listen and ask for clarification. Listening is critical to both sides. Take notes. If a patient does not understand the doctor’s answers, ask for clarification.

• Recognise style differences and take control. It’s important to remember that physicians view communication from a more medically-focused vantage point compared to patients, who concentrate on interpersonal aspects. While a majority of the patients want physicians to listen to their health concerns and also ask questions about their general health, only about half to less than one-third of the physicians consider it a must to do so. Patients need to realise that physicians, who also are trying to do their job, are most concerned that a patient thoroughly understands his or her condition, treatment options and likely outcomes.

• Follow up for more information. Patients should find out the best way to get information after an appointment. Can the office be called with additional questions? Is there a time when the doctor prefers to take phone calls? Could some questions be better addressed by a pharmacist or a nurse?

Here are a few communication tips for physicians from the Bayer Institute:

• Recognise the broader needs of patients. Physicians tend to define communication narrowly, focusing on the specific reason for the visit and the discussion of medical problems and treatment options. However, patients view the relationship with their physician in broader terms, placing greater importance on a more interactive discussion that extends to their general health. As a result, physicians need to expand their concept of good communication.

• Share responsibility. Work at taking responsibility for creating a relationship with each patient in which good and comfortable communication can exist. The Bayer Institute survey found that a majority of physicians (72 per cent) believe they, not the patient, are responsible for establishing good rapport, while another 25 per cent believe the responsibility is shared. In fact, more than one-third of consumers (36 per cent) believe that the responsibility is shared between the physician and the patient.

• Listen, ask and listen. Patients need to feel their doctor cares about them. The most visible way to demonstrate caring is by listening to a patient’s concerns about their specific condition and general health, asking questions and then listening carefully to the responses. Physicians tend not to recognise the importance of this. Only 52 per cent believe it is extremely important to listen to patients’ health concerns (as compared to 72 per cent of the patients). Only 29 per cent of the physicians (as compared to 66 per cent of the patients) think it is extremely important to ask questions about patients’ general health.

• Probe patients’ feelings about their condition. Patients feel much more strongly than physicians (55 per cent vs. 31 per cent) that it is important to their perceptions of high-quality medical care for a physician to discover and explore the patients’ beliefs about what is causing their problem and what might help them. In addition, more patients than physicians (53 per cent vs. 31 per cent) believe physicians should encourage them to state their treatment preferences.

• Watch tone of voice. Using the wrong tone of voice can inhibit a patient’s ability to communicate. In fact, this trait is rated extremely important by more than 60 per cent of the patients. Physicians should make sure their voice does not appear abrupt, rushed or angry and avoid "talking down" to patients as if they were children.

• Pay attention to body language. Physicians need to be careful that their body language does not contradict their words. Sitting across from a patient behind a large desk conveys distance and could be construed as a lack of openness. A better alternative is to sit by the side of the desk. Also, lack of eye contact is often interpreted as evasiveness or a lack of caring and attention. Physicians need to balance the time they spend reading a patient’s records with direct eye contact with the patient.

• Speak in understandable language. Talking in medical or technical terms that patients are not likely to know will only compound their anxiety and uncertainty. In fact, using easy-to-understand language is rated extremely important by nearly 70 per cent of the patients, the Bayer Institute survey shows. Physicians should ask patients to repeat any instructions to determine if they fully understand any prescribed treatments.

• Go the extra mile. Patients are apprehensive and deserve recognition. Physicians should show patients they are genuinely pleased to see them and go out of their way to convey that they care about their patients’ health. This can be done with a simple welcoming smile and handshake or even by walking the patient down the hall to the nurse.

— AF

TELL ME WHY

• Injections, injections and injections, painkillers and antibiotics. That is all that they keep administering to the patients. Dinesh Garg, 38, a banker

• The doctors keep experimenting with our lives. Ankur Virk, 18, a college student

• Gone are the days when a doctor used to detect the cause of an ailment just by looking at the way the patient walked. Now for a simple problem, they prescribe 10 tests. J. Gupta, 56, a businessman

• They are professionals. Practising medicine is no more a noble task. It is just another way of earning a lot of money. Karan Chopra, 28, marketing executive

• How can I trust a doctor if he charges Rs 100 just for consultation. Viney Sharma, 20, a student

Why are doctors so callous and apathetic? — A distraught patient

• I do not agree with them. Doctors are always concerned about their patients. Dr Rekha Gupta, 45, a gynaecologist.

• If things sometimes go wrong, it is not because of callousness on the part of the doctor. Perhaps it was something unavoidable. A doctor always works in the best interest of his patients. Dr Anita, 37, a gynaecologist.

• I do not think doctors are apathetic and callous. Dr A. K. Jain, 42, Associate Professor, Department of Ophthalmology.

• A doctor may be considered callous and apathetic by his patient because the latter thinks he is the only patient in this world, whereas the fact is that the doctor has to take give attention to all his patients in an unbiased manner. Dr Anuradha Sharma, 30.

• Why do dog owners allow their pets to dirty neighbourhood parks ? — An incensed resident

• Fine my neighbour isn’t fond of my dog, but why is he so intolerant of me?— An aggrieved dog lover

(Responses are sought from dog lovers and dog haters on these questions, respectively. Mention your name, age and address.)

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