Patient-Centered Care Begins With High Quality Doctor-Patient Communications

[tweetmeme source=”Healthmessaging” only_single=false]The first experience patients are likely to have with your hospital is not in an ER visit or inpatient stay.  A patient’s first experience will most likely be in one of your primary-care physician offices.  That because a person is 10 times more likely during a year to end up in the physician’s office for a routine visit than they are to require an overnight hospital stay.

As a hospital marketer or patient experience officer this should raise an interesting question. How well do your physicians–particularly your primary-care physicians–represent your brand?

Take “patient-centeredness.” Lots of hospitals these days are promoting themselves as providing patient-centered care.  You know … when the hospital and its staff try where possible to be sensitive to and honor the wishes of patients.   But when it comes to patient-centeredness, “walking the talk” is a hard in in physician offices and even tougher in the hospital.

The fact is that most physicians, with some exceptions, are anything but patient-centered in their interaction with patients.   Take the way physicians and patients tend to communicate with one another.   An estimated two-thirds of physicians employ what is known as a physician-directed or paternalistic style when talking with patients.   This is when the physician asks the questions, interrupts the patient as needed, and only provides information the physician thinks the patient needs and is capable of understanding.

The sad thing is that most patients have gotten used to and, in some cases, like being told what to do and how to think by their doctor.   It just the way things are.   This attitude is perhaps why so many patients consistently give their doctors high marks on global satisfaction surveys dealing with communications. Patients are so used to way things are that they cannot conceive of a better way of doing things.   It’s also been shown that dissatisfied patients don’t bother filling out satisfaction surveys.   If they did, what they would say is that their doctors have communication habits like my doctor:

  • Doesn’t listen
  • Ignores my opinion
  • Talks down to me
  • Always seems rushed and inattentive

So what are hospital marketers and patient experience officers supposed to do about physician-patient communications?

  1. Don’t put too much stock in global patient satisfaction surveys that barely address physician-patient communications
  2. Conduct dedicated communication surveys, focus groups, and communication audits of individual physicians to assess the real scoop when it comes to the quality of doctor-patient communications
  3. Teach patients how to do a better job of communicating with physicians
  4. Provide continuing education training and tips aimed at improving the patient-centered communication skills of physicians

In 2012, the quality of the physician-patient experience will make up a sizable percent of Medicare hospital reimbursement.  Individual physician reimbursement will be affected as well.

Smart hospital marketers and patient experience officers should consider ways to leverage these changes in Medicare reimbursement, as well as the myriad of pay-for-performance initiatives, to make sure the patient’s first impression of your hospital is outstanding!

That is my opinion.  What do you think?

This post is a reprint of a guest post I wrote for another excellent blog Hospital Impact. 

7 responses to “Patient-Centered Care Begins With High Quality Doctor-Patient Communications

  1. How about make a way for the surveys to *actually* be anonymous? So many times I see those forms next to just a simple cardboard box with a small slit in the top. What’s to keep the staff from opening that box, fishing out my comment, and knowing that *I’m* the one who said something negative? Will I be praised for calling attention to an opportunity for improved relations? Or am I likely more likely to experience a cold shoulder the next time I show up?

    It’s not that I can’t *conceive* of a better way of doing things. I know lots of better ways of doing things. But I’m not the one who can effect any change. I’ve gotten used to being told what to do by my doctor because that’s, as far as I can tell, how doctors are trained the doctor-patient relationship *should* be: authoritarian.

    I had an ER doctor lie to me a few weeks ago trying to tell me that my heart rate monitor line was actually my breathing. Really?? I can hold my breath and see that the line keeps going. I’m not *that* dumb. Then I go home to find out that the sine-wave type heart rate I was displaying is a sign of too much potassium in the blood. I have Addison’s Disease. That’s a VERY important symptom for me to watch out for. No test were done. Nothing.

    And this isn’t my first time running into a doctor completely ignoring me and my symptoms. I *expect* it at this point. I go online and I do my own research because I know I can’t rely on doctors. But they’re the gatekeepers to treatment. So either I sit in the office and nod and smile and play the naive, obedient patient… or I vote with my feet. What other choice do I have?

  2. This is totally true! Especially in public hospitals where doctors are supposed to have a round ward after ward. I mean, even if there are a lot of patients to attend to, doctors should know that EVERY case is important! If only patients can tip a doctor just to stay longer, (like when you’re in a casino and if you want to get a nice pitch, you shell out a few dollars and pay an employee). Well, there are online casino games now, which are way better. Can there be online doctors too? Hmmm. What if it’s possible? Makes me think.

  3. You ask, “How well do your physicians–particularly your primary-care physicians–represent your brand?”
    The fact is that — unless the doctors works for the hospital — they represent their own brand. Doctors are patient-focused. When they make rounds, they are taking care of their patients and doing so in a way that is consistent with their own personal or practice brand, i.e., their belief system. Hospital administrators who think private practice primary care doctors are consciously representing the hospital brand are kidding themselves.

  4. Good analysis, hope it motivates… I love your number 3 recommendation ‘3.Teach patients how to do a better job of communicating with physicians’. I myself am a patient (in the Netherlands) and I am convinced that we could gain a lot when patients are able to take responsibility for their living with a disease. They can not simply depend on a doctor whom they see 2 times a year for 10 minutes while being on their own a little less than 9,000 hours a year. They should be able to observe closely what happens to them , to provide accurate information, to ask the right questions to the right person and so on. This calls for communication skills!
    However, patient education is not only about teaching how to properly take medication, it is about management skills, including communication skills.

  5. Pingback: Patient-Centered Care Begins With High Quality Doctor-Patient Communications | Health literacy |

  6. I think that systemically, doctors also need to be rewarded for good communication. If your system treats physicians, nurses & other skilled providers like factory production workers, it’s unrealistic to expect that these folks will be motivated and empowered to do great patient communication. And having concentrated health literacy assessment and advancement programs can improve communication both from doctor to patient and from patient to doctor.

    • Ann,

      Thanks for your comments. Hmmm. Let me restate your suggestion. Doctors should be paid an additional amount for engaging in patient-centered communications (the defacto gold standard) with patients. Is that correct?

      What if I told you that employing patient-centered communications techniques added only 6 seconds to the typical office visit (which presumably was more physician-directed in communication style)? I can provide you a copy of the article.

      Fundamentally I agree that physician reimbursement needs to be addressed. What measures would you suggest be used to assess the quality of physician-patient communications needed to support a higher level of reimbursement?

      Steve Wilkins

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s