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Mind The Gap 
I don’t believe in silver bullets. Good communication is necessary but not sufficient to improve health care.
Thanks for your comment. The evidence does not agree with your opinion. High quality physician-patient has been shown to improve outcomes, improve quality and increase patient satisfaction.
Steve Wilkins
WOuld you have links to the evidence you refer to? Be mighty helpful for me to quote to the doubters.
Thanks!
Kathy
Kathy,
If you could be more specific as to which references you want I’d be happy to list them.
Steve Wilkins
Surely there is no evidence that communication would cure all of health care’s ills–that is what a magic bullet is, right? If this evidence exists, please cite it. If not, please don’t oversell what communication can do. As I said before, good communication is NECESSARY, but it is surely not sufficient to fix what ails our health care system.
Note that the title of this post was closed with a question mark…not a period.
Having said that, I have yet to see or hear of an intervention other than improved physician-patient communication that 1) has been shown to uniformly improves all aspects of care delivery Show in the graphic, including adherence and satisfaction (patient and provider) 2) is easy to implement relative to other interventions like PCMH and ACOs, 3) causes little disruption to physician office workflow – including requiring no additional staff, and 4) is a relatively inexpensive solution compared to the alternatives. The only thing it won’t fix is increased reimbursement for talking to patients – but should physicians already be doing this??
Can you suggest an intervention with this potential?
Thanks for your comments as always!
Steve Wilkins
To the doubters, I spent 15 years doing patient satisfaction research for Kaiser Permanente and Stephen is right. In analyzing my enormous data sets, I found that high quality physician-patient communications was consistently shown to be correlated with higher levels of trust, improved compliance, better outcomes and increased patient and physician satisfaction. Enough so to direct policy and practice. Patients want a health partner and advocate in their physician. That requires a trusting relationship and trusting relationships require effective and consistent communications.
Nancy,
Thanks for you comments. Question. Just about every hospital and physician gets high scores from patients on overall satisfaction…and willingness to recommend using CAHPS or HCAHPS. And with this hospital folks assume that they are doing everything…including physician patient communication …very well. End of story…we don’t have a communication problem at out facility.
But when you drill down…or over lay findings from published studies…you see that most patients feel rushed, that their doctors don’t listen, are afraid to ask questions, don’t get as much health info as they would like, etc. Yet patient still give them high scores for communication…..how should these types of findings be interpreted?
Thanks,
Steve Wilkins
And shown to significantly improve safety too.
Could we maybe share some ideas about good communication.. I doubt we want or intend to be poor communicators. There are many challenges: time, exspectations, non-aligned goals, fear, power differential, clinical ‘ quality measures”.. just to start the list. … I am asking patients for their goals .. the WHY of why they would like good health.. After the list of ” shoulds” that first come.. ” I should lose weight” ” I should exercise”.. I try to explore WHY… what would that get you? Then maybe I can help them meet THEIR GOALS, rather than trying to meet my goals for them.
Would love to hear more ideas.
As a patient, for me communication includes: acknowledgment (I hear ya, I understand) interest (instead of ‘how are you feeling’ – how are you ‘dealing’) and being aware that often even simple – one and two syllable words – can confound us when heard out of context: stool, gait, treat, coated, static are a few that I’ve collected…
http://www.ability4life.com/2010/08/medical-jargon-even-single-syllable-words-can-confound/
Ellen,
The problem with blogs is that the answer to individual questions like your – examples or ideas of good communication, as well as citations to additional resources…are spread through different posts on this blog. My suggestion is to search out the topics in which you have an interest.
My client engagements are much more directive as to communication strategies and techniques. Unfortunately we all have to make a living and can’t give everything away for free.
Communication is a three-legged stool: sender, message and recipient. The patient-as-recipient will almost always be at a disadvantage.
I’m a fan of teachback
Click to access healthliteracyarticle.pdf
Thanks for your comments! The Teach Back method has a lot of fans…
Add the factors of seniors being hard of hearing and emotionally compromised when they are ill, and communication becomes even more challenging. How about the need to communicate with the clearer-minded, (sometimes younger) care givers of the elderly? But this could start a game of “Telephone”… unless a physician and the follow-up care team are aware of how care-givers influence adherence and communicate effectively with them as well as with the patient, effective communication will likely remain an elusive thing.
As a Health care auditor and Registered Nurse, I cannot agree more with the statement that good communication can help improve healthcare. Caring itself is so lacking in this country ( South Africa) that in my opinion just being able to LISTEN and OBSERVE ( communication includes the non verbal as well) would improve the patients condition. However not only between physician and patient but all other health care providers as well. I have had first hand experience of poor communication with subsequent deterioration in the health of the patient as well as noting that the occasion when communication was good – there was an exponential improvement in the overall patient health.