[tweetmeme http://www.healthecommunications.wordpress.com%5DIf the lack of time is the chief barrier to poor physician-patient communications, it logically follows that longer patient appointments are the solution. Ok…lets’ say that I could wave a magic wand and add 5 or even 10 more minutes to the average primary care office visit. Would more time really make a difference?
Probably not. A quick examination of just some of the key drivers of physician-patient communications reveals why:
- More Time Will Not Change How Physicians View the Physician-Patient Relationship
A physician’s communication style is a “window” into how they view the physician-patient relationship, e.g., physician-centered versus patient-centered. One landmark study of physician communication styles found that almost two-thirds of physicians (IM and FP) in the study had a physician-centered view of how physicians and patients should relate to one-another.
- More Time Will Not Change a Physician’s Communication Style
While even the most physician-centered physician can incorporate elements of patient-centered communication in the medical interview process, the reality is that providers revert back to type. A provider with physician-centered directed orientation will still most likely interrupt the patient, not ask if the patient has questions and not use “teach-back” to make sure the patient understood what the physician said and so on.
- More Time Will Not Likely Change a Physician’s Reliance on Observable Patient Characteristics When Deciding How to Treat Patients
In addition to observable patient characteristics like age, gender, race and education, there is the person “behind the disease” who comes to the doctor with their own set of health beliefs, life experiences and treatment preferences. When the physician recommends a treatment that the patient does not believe will work, the likelihood of patient non-adherence is much greater than if the physician took the time to ask the patient their thoughts and collaborate with the patient on exploring the treatment that will work for both parties.
Time is not the problem when it comes to improving physician-patient communications. I don’t really believe that additional reimbursement to physicians for sub-optimal patient communications is the answer either.
Numerous studies have shown that patient-centered communication techniques in primary care practices can improve patient outcomes, change behavior and increase patient and provider satisfaction without increasing the length of the office visit.
So how do we improve the quality of physician-patient communications? I have some thoughts that I will share with you in future posts. In the mean time…please let me know what you think.
Sources:
Roter, D. et al. Communication Patterns of Primary Care Physicians. JAMA. 1997:277:350-356.
Mauksch, L. et al. Relationship, Communication, and Efficiency in the Medical Encounter. Archives of Internal Medicine. 2008;168(13):1387-1395.
Aita, V. et al. Patient-centered care and communication in primary care practice: what is involved? Patient Education and Counseling. 58 (2005) 296–304.
Braddock, C. et al. The Doctor Will See You Shortly – The Ethical Significance of Time for the Patient-Physician Relationship. Journal General Internal Medicine. 2005 November; 20(11): 1057–1062.
Mind The Gap 
Excellent post. Patients are more compliant with treatment when there is good rapport with the provider. I believe there is also a real placebo-type effect with good rapport, where patients feel cared about which clearly contributes to healing. Thanks.
Robert,
Thanks for the kind words. You are right about the beneficial aspects of a positive relationship between patient and physician. Patients that rate their relationship with their doctor as excellent or very good, have better outcomes, are more likely to comply with the doctor’s recommendations and so on compared to patients with the same medical problems but reporting a less than optimal physician relationship.
How true. Another aspect of physician-centered communication is that many don’t even realize how little knowledge some their patients might have about treatment plans/options or disease processes. When I worked for a medical communications company producing newsletters for client hospitals, I called physicians to interview them for a story about their practice specialty. You’d be amazed by how many of them would say, “Why are you writing about that? Everyone already knows all about that topic.” Then, after the article was published, some of them wanted to know why I “dumbed down” their esoteric medical terminology and buzz words. If that attitude characterizes their private patient communications, all I can say is YIKES!
Beverly,
Thanks for your thoughts. A often quoted study found that physicians do indeed tend to underestimate the patient’s interest in receiving health information and over estimate how much information they actually do give to patients.
I have found this to be true, mostly because we initiate the Office Visit with our agenda, which does not allow for the patient to feel like his concerns were addressed. Especially if the visit is focused on a consequence of the patients behavior which remains hidden dure to the lack of interest by the physician to uncover the root cause. How many times do we increase medication, when adherance is the issue, or initiate tests based on preconsieved diagnosis.
Several 15 minute OV are more effective in understanding medical conditions than the yearly physical. One must consider the motivation or lack of for each patient before care can be effective..
I found this thoughtful post to be extremely valuable, as the lack-of-time argument is so pervasive that I accepted it as a given. Upon applying a few minutes of critical thinking to the issue, it is easy to see the flaws in the accepted version of the story. I have taught over 1,500 doctors how to market and grow their practice or hospital, and I can see how a certain percentage of them would fare no better if they had all the time in the world.
Pingback: Poor Physician-Patient Communication – Is “Lack of Time” Really the Problem? | healthcare technology | Scoop.it
Pingback: Poor Physician-Patient Communication – Is “Lack of Time” Really the Problem? | Digital Health Journal