Ten Reasons Why Hospitals, Health Plans And Medical Groups Should Invest In Developing Their Physicians’ Patient-Centered Communication Skills


“Patients are, in fact, overly patient; they put up with unnecessary discomforts and grant their doctors the benefit of every doubt, until deficiencies in care are too manifest to be overlooked.  Generally speaking, one can assume that the quality of care is, actually, worse than surveys of patient satisfaction would seem to show.  Patients need to be taught to be less patient, more critical, more assertive.”

Avedis Donabedian, MD.   Father of Health Care Quality

Black Woman and DoctorIt’s no secret that poor communication tops the list of patient complaints about their physicians.  Who hasn’t heard a physician or an enabling administrator say that they “don’t have time to talk to patients” or that they “don’t get paid for talking to patients.”  While understandable, that kind of a response seems to demean the interpersonal exchange which is the very essence of the physician-patient relationship.

Contrary to what most people think, the quality of a physician’s patient communication skills impacts far more than the patient experience.   The quality of your physicians’ patient communication skills drives the quality of the patient’s diagnosis, treatment, outcome and cost.   And that my friends should get your attention.

If 30+ years of evidence is to be believed, there is a practicable solution to today’s physician-patient communication funk everyone finds themselves in.   It’s called patient-centered communications

Here are 10 evidence-based reasons why providers and payers should go beyond useless global measures of patient communication and give serious thought to assessing and improving their physicians’ patient-centered communication skills.

  1.  Improve visit productivity – collaborative setting of a visit agenda and negotiation of visit expectations by patient and physician have been show as a way to reduce the “oh by the way” comments at the end of the visit and to allow more to be accomplished often in less time.  1
  2. Improve the patient experience – the duration of the visit is not nearly as important to patients as the quality of time spent face-to-face with the physician.  Visits in which the physician invites patient participation and makes the patient feel heard and understood produce higher satisfaction and experience scores. 1
  3. Increase patient engagement – patients come to physicians for a reason(s).  They are already engaged otherwise they wouldn’t be there.  Patient-centered physicians solicit the patient’s reasons for the visit, their ideas about what’s wrong and their thoughts regarding what they want the physician to do.   It helps eliminate guessing and unfulfilled patient expectations.
  4. Improve patient adherence –  “Patient beliefs about medication were more powerful predictors of adherence than their clinical and socio-demographic factors, accounting for 19% of the explained variance in adherence. ”  By understanding where the patient is coming from physicians can avoid wasting time recommending treatments which patients will not adhere to, i.e., prescribing a new Rx when patient would prefer life style modifications. 2
  5. Fewer requests for expensive tests – strong physician-patient relationships characterized by effective patient-centered communication skills report higher levels of patient trust in the doctor and lower levels of patient requests for expensive diagnostic tests commonly found in physician-patient relationships reporting lower levels of patient trust in physician. 3
  6. Fewer ER visits and hospital readmissions – patients in strong patient-centered physician relationships are more likely to engage in the kinds of self care management behaviors which preclude ER visits and rehospitalizations.  3
  7. Better patient outcomes – Chronic disease patients of physicians with strong patient-centered communication skills are consistently found in studies to report better A1C scores, better controlled hypertension and asthma, and so on. 4
  8. Reduce malpractice risk – The majority of malpractice claims involve some form of communication breakdown between physician and patient.   Patient-centered physician-patient relationships are characterized by a high degree of relevant and timely information exchange which greatly reduces the risk of physician-patient communication errors. 5
  9. Reduce disparities in care – The evidence shows that physicians tend to be more paternalistic and directive when talking with ethnic patients, including sharing less information, compared to when communicating with white patients. 6
  10. Increased reimbursement – CMS and many commercial payers now offer incentive payments for outcomes linked to patient-centered communications. i.e., patient experience, reduced ER visits and hospital readmissions, use of generic vs. brand drugs, lower levels of expensive diagnostic tests, etc.

Note:  Later this Summer, Mind the Gap will be organizing a communication challenge called Adopt One! TM.   The goal of the event will be to challenge physicians and their care teams to adopt one new patient-centered communication skill within the next 12 months.

As part of the Adopt One! Challenge physicians and their care teams will have the opportunity to sign up for a free evaluation of their patient-centered communication skills, have their skills benchmarked against best practices and  receive a report detailing their findings and recommended steps for improvement. 

 Sources:

1        Dugdale, D. C., Epstein, R., & Pantilat, S. Z.  Time and the patient-physician relationship. Journal of General Internal Medicine, 14 Suppl 1, S34-40.  1999.

2       Horne, R., & Weinman, J.  Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness.  Journal of Psychosomatic Research, Vol. 47, No. 6, pp. 555–567, 1999.

3        Thom, D. H., Hall, M. a., & Pawlson, L. G. (2004). Measuring Patients’ Trust In Physicians When Assessing Quality Of Care. Health Affairs, 23(4), 124-132.

4       Stewart, M. . et al. (2000). The Impact of Patient-Centered Care on Outcomes. Journal of Family Practice, 49(No. 9), 1-9.

5        Levinson, W., Roter, D. L., Mullooly, J. P., Dull, V. T., & Frankel, R. M. (1997). Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons. JAMA : the Journal of the American Medical Association, 277(7), 553-9.

6       Johnson, R. L., Roter, D., Powe, N. R., & Cooper, L. a. (2004). Patient race/ethnicity and quality of patient-physician communication during medical visits. American journal of public health, 94(12), 2084-90.

6 responses to “Ten Reasons Why Hospitals, Health Plans And Medical Groups Should Invest In Developing Their Physicians’ Patient-Centered Communication Skills

  1. Good Evening, I came across your blog tonight as I have spent many hours of my life for the past year searching for an organization to share my story and trying my hardest to find a way to help make a change for the next family. Your posts speak so close to my heart having endured months in a hospital when my husband was so very ill this time last year. My husband has Crohns Disease. Last Memorial Day weekend, he became very ill and went to our local ER. The Drs. there were “uncertain” if he had ruptured his appendix, or was forming an abscess due to his Crohns disease. They cared for him by draining the abscess and putting him on IV antibiotics and sent him home a few days later. I was very concerned as I had spent my evenings reading about ruptured appendix etc and kept saying “what if it is the appendix that has ruptured, wont he become septic and die?”. I was told such things as “if it is the appendix, it will slough off” and “that’s true, sepsis does kill, but dont talk that way in front of him”. Non sense…. Angered, but we had no choice, we had to leave the hospital.

    A few days later, his fever went up, and his heart was racing. I took him to another ER. They admitted him, deemed it wasn’t Crohns related and scheduled him to have his appendix removed. Mind you, he was septic at this point as a week had passed since the appendix ruptured. He came out of that surgery very ill and in great pain. He remained in the hospital just three days, and then was told he could go home and would have a home nurse. He argued that he was in a great amount of pain, I even called the rapid response team of the hospital at one point because he was in so much pain.

    In 24 hours of being home, the home nurse called the surgical team and insisted (they gave her arguement) that he come back. He got back to the hospital and was very ill with high fever and racing heart again, by now, I was well informed due to my reading that he was septic and things were not going to be good if he didn’t get proper care. The admitted him, and once again after a few days on IV antibiotic, sent him home and insisted all of his “pain” was normal.

    In just 24 hours again (by now, it was Fathers Day, mid June) he was sick again, and this time barely concious. I took him back to the hospital for now a third time. I was angry and literally chasing Drs and nurses for help. I basically was told that he was fine and that everything that was happening to him was to be expected. He had green puss coming out of his abdominal drains that were left in him after surgery, I said “this is not normal”. I was told they would admit him and a Dr from his “team” would come see him in the morning. By now, he had last 18lbs, was extremely weak and literally getting poisoned to death. I asked for a transfer to another hospital and was told “we can’t do that, you need to find a Dr who will accept you there to make the transfer, or you can leave our hospital at your own will and drive him there”. I was furious. I called the other hospital (now hospital 3) and had him transferred.

    This is a very long story, and one I wish I could share with you in more detail as there were so many “gaps” he/we fell into along the way; truly horrifying to say the least, but I was determined not to let him die. I was his advocate and I would fight whoever I had to for his recovery .

    In hospital 3, we found out that he was suffering from a Crohns induced ruptured appendix, the area where the appendix was removed (lapriscopically) was leaking, so now he had a bowel leak and he had peritonitis (infection all in his abdominal wall). He would spike fevers of 104 and his heart would race in the 140s. He was told that there was air in his abdomen (this is what proved a bowel leak) and he had to have emergency surgery. They took him in in grave condition and ended up removing 16 inches of bowel and had to wash him out several times, so much so that they had to leave a vacuum on his abdomen and couldn’t suture him due to the risk of reinfection. They saved his life, but in the end he had lost 30lbs, endured so much pain, had to have a temporary ostomy bag, was out of work from May-October. I was so thankful my husband lived, as we have two four year olds and he was way to young to die and leave them fatherless. I was angered because I knew had I not ran up and down hallways, chasing Drs and pleading for his help, he would not have lived. There is not a day that goes by that I dont get upset. I have contacted the hospital that I feel didn’t care for him and put in him danger and spoken with their patient safety advisor, only to be told that they were “researching the case” and “thank you for sharing your story to help ensure safety of patients in the future” but nothing they would find could be shared with me.

    I sought no monetary gain for this, no legal advice. All I wanted was answers adn for those who I felt put him in harms way to have to own up to their mistakes, errors, or possible oversights. I wanted to be heard, and I wanted it to be known by the first two hospitals that he endured so much after they “set him free” saying he “was fine”. And by the way, ruptured appendixes dont “slough off”….

    I am extremely passionate, so much so that I spend most of my nights trying to find a way to help those in hospitals. It seems as there is no organization for me to be able to do this. I reach out to you, hoping you will find my story touching, but most importantly, I want you to know how much I support your efforts. My husband almost died last year. A good doctor ended up saving his life, but the hurdles I personally had to jump through to get someone to listen, care and take action were pitiful.

    • Lora,

      I suggest you go to the Medically Induced Trauma Support Services website at
      http://mitss.org/ and share your story with them. There are many people who have dedicated their time to trying to ensure that what happened to them doesn’t happen to someone else. This is one such group. Good Luck!

    • How very horrifying for you and your family! I am so sorry!

      RN for > 30 years

  2. Great post and I would add one more reason that is even more important to the doctor than all the rest.

    It is more satisfying and less draining for the doctor to be in a collaborative relationship rather than “giving orders” and expecting “compliance”. You and the patient become a team and begin to row in the same direction. Much less stressful and wearing on the doctor. It lowers risk of burnout and increases fulfillment and satisfaction. This upleveling of the doctor’s set point of wellbeing produces ripples throughout their practice (and at home).

    Dike
    Dike Drummond MD
    http://www.thehappymd.com

  3. chuck edelstein

    Traditionally, many of our public schools and higher education institutions had courses in writing and speaking but few expressly on listening. Some disciplines stressed listening and more broadly communication than others. Till recently, schools followed the pedagogy model, teacher centered, in which the teacher was the repository of truth. Fortunately there has been some improvement . Andragogy, a term which gained some credence as a result of the work Malcolm Knowles and others was based in part, on the notion that adults learn best when they are engaged in solving problems relevant to their felt needs. Much of lecture and lecture/discussion teaching methods were replace by small task groups which reported the group’s work to the rest of the class. pretty much now old hat in some places. The Institute for Court Management founded in the early 1970’s followed the andragoglical model. I was a student (called participant) there and later taught there and was given magnificent title of associate dean. By and large, Knowles was right on the money. The guest faculty with great content knowledge but poor teaching skills shined. Great for them and the students.

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