Tag Archives: health information seeking

Three Reasons Why Doctors Need To Spend More Time Talking and Listening To Their Patients

Since most physicians probably will not be able to get beyond the first couple of lines of this post without yelling at the monitor…I will get to the 3 reasons…and if you stick with me …I’ll present my case for why they are so important.

  1. Your visits will be more productive…and shorter
  2. You will be a better diagnostician and a much better doctor
  3. Your patients will sing your praises to all their friends and family

Reason #1- Your visits will be more productive…and shorter.

Physician experts argue that the best way to improve productivity and time management during the office visit is by improving the way physicians talk with their patients.  Most of you are probably screaming this is not possible because patients:

  • Show up with 3-4 complaints/visit
  • Just want a “quick fix “or prescription
  • Are unfocused and make rambling opening statements
  • Appear totally disinterested and unengaged
  •  Won’t do what I tell them

Let’s stipulate that all these arguments are true.

Now suspend your judgment for a moment and consider this.

Where is it that patients are taught how they are supposed to behave when in the presence of their doctor?   Have you ever talked to them about such things?  Do you imagine their previous doctors advised them about such things?  Is there a school people are supposed to go to learn how to talk productively with your doctor?

The fact is that patients aren’t taught these things….ever.  They learn these behaviors through the school of hard knocks.  We have all been socialized from childhood to assume the “passive, subservient “sick role” in the presence of our doctors.  That’s not anyone’s fault…it is just the reality of the way health care have evolved.

Now imagine there was a school for patients where they learned things like how the medical interview is structured, what patients can do to prepare for their visit, why time is limited, how to make the best use of the time available, and so on. Then imagine you reinforcing these “learning” at each of your patient visits through repetition, encouragement, and changes in your communication behavior.  In relatively short order patients would begin to “reciprocate“your behavior with the behavior you desire…and viola you have set the stage for shorter, more productive (and organized visits).

Reason #2- You will be a better diagnostician and a much better doctor

Sir William Osler, a founding father of modern medicine, once said “Listen to the patient – they will tell you what’s wrong.”  Numerous other luminaries have said that a doctor’s patient communication skills (talking and listening) are as important as their clinical skills and knowledge.  Talking and listening is how physicians arrive at the correct diagnosis and treatment.  Strong patient communication skills are needed to engage and activate patients.   Talking and listening is therapeutic and to patients.

Some patients will get better with a commonsense explanation of their difficulties; others for some unknown reason remain unchanged. Some patients will respond to friendliness on the part of their physician; others require a more formal attitude. Some can establish rapport with their physician even though they appreciate his intellectual shortcomings.       M. Balint 1957

As physicians come to rely upon EMRs, there is a risk that the computer will come between the patient and physician.  This will result in even less “talking and listening” between patients and physicians, more   disengaged patients, and even poorer outcomes.

Reason #3 – Your patients will sing your praises to all their friends and family  

Let’s face it…with few exceptions…most physicians’ patient communication skills need improvement.   Poor physician communications skills top the list of complaints patients have about their doctor, i.e., physicians that don’t listen, physicians that ignore what they have to say, physicians that don’t provide enough information, and so on.    Many of us have never been exposed to a physician with superlative patient communication skills.   We don’t know what we are missing.

Given how “average” most physician communication skills are…. imagine how easy it would be for a physician with good communication skills (patient-centered) to compete with other physicians in your group or local market.  Soon such physicians will also be rewarded for their ability to create exceptional patient experiences simply by virtue of their ability to talk and listen to patients.

Is what I talk about here counter intuitive…yes.  Does it requires some out of the box thinking…definitely.   Do I have a solution for helping patients and physicians accomplish what I talk about here.   Absolutely.   Contact me to learn more.

That’s my opinion…what’s yours?


Electronic Medical Records and Communication with Patients and Other Clinicians: Are We Talking Less?  Center for Study of Health System Change. Issue Brief. April 2010.

Balint, M. The doctor, his patient and the illness, Inter-national Universities Press, New York, 1957.

Rosenow, E., Patients’ Understanding of and Compliance With Medications:  The Sixth Vital Sign. Mayo Clinic Proceedings. August 2005.

Cene, C., et al. The Effect of Patient Race and Blood Pressure Control on Patient-Physician Communication. Journal of General Internal Medicine. July 3, 2009. 24(9):1057–64.

Improving The Way Doctors And Patients Communicate – A Silver Bullet For Fixing What’s Wrong With Health Care?

Physician_Patient Communications InfographicSometimes a picture is worth a thousand words…

Does Physician Denial Of Patient Requests Result In Decreased Patient Satisfaction?

[tweetmeme source=”Healthmessaging” only_single=false]The short answer: No.
At least not in the context of a strong physician-patient relationship.
Many physicians have legitimate concerns about the prospects of having their salary or level reimbursement linked to patient satisfaction. I would too given the way most health care providers go about measuring and interpreting patient satisfaction data.
A major concern of physicians is the issue of patient requests – particularly the impact of unfulfilled (and unreasonable) requests upon patient satisfaction. According to researchers, explicit patient requests for medications, diagnostic tests and specialty referrals occur in between 25% to 40% of primary care visits. This figure is much higher when requests for information are factored in.
In studies, primary care physicians accommodate patient requests for medications and diagnostic tests approximately 75% of the time. Physicians however accommodated only 40% of specialist referral requests. Physicians negotiated alternatives solutions to patient requests 22% of the time and denied patient requests the remaining 3% of the time. Information requests were met approximately 95% of the time by physicians.
Denial Of Patient Requests Has Little Impact On Patient Satisfaction
It is not at all clear from the research that physician denial of patient requests for medications, tests or specialist referrals has any negative effect on patient satisfaction. In the studies referenced here, little to no association was found between unfulfilled patient requests and patient satisfaction.
The one exception to this finding is where physicians fail to meet patient requests for health information. In such instances patient satisfaction was lower. This is not surprising when one study categorized the quality of physician responses to patient information requests as follows:

  • 32% were of requests were fulfilled with a “terse” physician response
  • 33% percent were fulfilled with an “intermediate” response
  • 32% percent with an “elaborate” response.

Experts Advise Negotiating Patients Requests
It has been said that clinical encounters such as occur during office visits involve a “process of negotiation between the clinician and patient.” As such, physicians are advised to use the influence accorded them by their patients to help them understand the pros and cons of their request so as to negotiate actions are really needed.
Physicians that are truly concerned about their patient satisfaction score are better served by looking after the quality of their patient communications skills.

Kravitz RL, Bell R a, Franz CE, et al. Characterizing patient requests and physician responses in office practice. Health Services Research. 2002;37(1):217-38.

Kravitz RL, Bell R a, Azari R, et al. Direct observation of requests for clinical services in office practice: what do patients want and do they get it? Archives of Internal Medicine. 2003;163(14):1673-81.

Peck BM, Asch DA, Goold SD, et al. Measuring Patient Expectations – Does the Instrument Affect Satisfaction or Expectations? Medical Care, Vol. 39, No. 1 pp. 100-108.

Keitz S a, Stechuchak KM, Grambow SC, Koropchak CM, Tulsky J. Behind closed doors: management of patient expectations in primary care practices. Archives of Internal Medicine. 2007;167(5):445-52.

What doctors really think about women who are ‘Medical Googlers’

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The following is a guest post by Carolyn Thomas, a heart attack survivor and e-patient who excellent blogs talks about her experiences and lessons learned at Heart Sisters.
Me: “My name is Carolyn, and I’m a Medical Googler.”

You, all together now: “Hello Carolyn!”

This will come as no surprise to any of you regular readers, but I’m just a wee bit obsessed about All Things Cardiac. From the minute I was sent home from hospital last May following my heart attack, I started mainlining Google like it was a drug, and I became hooked. I threw myself into researching women’s heart disease in a determined attempt to figure out what the heck had just hit me. And after I had the opportunity to spend five days at Mayo Clinic in October, I became truly insufferable.

That’s how I happened to learn about the WomenHeart Science & Leadership Symposium for Women with Heart Disease at Mayo Clinic last fall:   I found it on Google.  That’s how I found hundreds of other Heart Sisters – all survivors like me – on the National Coalition for Women With Heart Disease WomenHeart online support community. I found them on Google. And that’s how I began subscribing to regular cardiology news bulletins from medical journals, clinical research sites, and university heart institutes.  I found them all on Google.

And that is also how I came to inform my cardiologist last month during my regular follow-up visit that doctors should no longer be prescribing the drugs Plavix and Wellbutrin together anymore, because, yes, I’d found the FDA Drug Alert on Google. But he told me that he had not yet heard about this Drug Alert – one full week after the warning had been issued.

I am, apparently, a doctor’s worse nightmare now.

Dr. Stuart Foxman of the College of Physicians and Surgeons of Ontario implied as much in his blog for physicians called DocTalk. He wrote about the growing phenomenon of patients who are now self-educated Medical Googlers.  One study found that many physicians rate the know-it-all Googler as somewhere between “frustrating” and “irritating”.

The study noted a number of doctors’ concerns.  Some patients used the information gleaned on their own for self-diagnosis or self-treatment. Some doctors believed that the information caused the patient unnecessary confusion and distress. “All of these seem like legitimate concerns on the part of physicians,” explains Dr. Foxman.

But he notes that the doctors surveyed in this study expressed other concerns, too.

“The highly curious and informed patients were sometimes perceived as ‘challenging’ with a tendency to test the knowledge of physicians. Some doctors felt that these patients were overly assertive, undermined their authority, and did not show sufficient trust in their health care provider.”

Dr. Scott Haig‘s Time magazine essay called ‘When The Patient Is A Googler’ is a scathingly arrogant attack, describing his Googling patients as “suspicious and distrustful, their pressured sentences bursting with misused, mispronounced words and half-baked ideas.”

Just a tad oversensitive to having his authority undermined, perhaps?

Dr. Haig writes:

“Some patients don’t want to know what’s wrong with them, what medicines they’re taking, or even what kind of operation you’re planning to do on them. ‘Just get me better, Doc,’ is all they say.”

Now there’s a nice, compliant, well-behaved kind of patient who would never even dream of undermining Dr. Haig’s authority by trying to learn about their medical condition and then coming up with all those half-baked ideas.

Attention Dr. Haig, and others of your ilk: if enough women continue to have their symptoms dismissed or minimized or  – worse! – misdiagnosed (as I did when the ER doc told me I was just having acid reflux instead of a heart attack), then you can expect more and more of your patients to start doing their own Googling research in an effort to educate themselves as much as possible about what is happening to their own bodies.

The clear reality is that the volume of medical, health and wellness material that is readily available out there, and the number of people who regularly access it, are both increasing, whether Dr. Haig likes it or not.

The website WebMD alone gets over 40 million visits every month. Up to 80% of internet users have sought medical information online.  And a reported two-thirds of patients apparently want their doctors to recommend reliable website resources for them.

Dr. Foxman adds that there are, of course, ‘cyberchondriacs’ who believe that whatever condition they’ve read about on the internet must be the horrible ailment they have. And the amount of sheer unadulterated trash online is mind-boggling.  That’s why Dr. Foxman recommends reputable patient resource sites like the Public Health Agency of Canada.

Medical Googling is not only for those patients who want to sincerely learn and ask questions about their own health, but online searches can also be a diagnostic tool for physicians. Australian researchers reported in the British Medical Journal on their study that chose 3-5 search terms for hard-to-diagnose illnesses, and then looked at how Google did compared with reports published in the New England Journal of Medicine. The study found that doctors who use Google to help diagnose difficult cases can find a correct diagnosis over 60% of the time.

I now wish that the ER doc who sent me home in mid-heart attack with an acid reflux misdiagnosis had instead tried Googling my symptoms (crushing chest pain, nausea, sweating and pain radiating down my left arm).  I’m now fairly confident that Google would have steered him to the correct diagnosis of myocardial infarction!

The British Medical Journal also notes that doctors have been estimated to carry an astonishing two million facts in their heads to help them diagnose illness – but Google gives them quick access to more than three billion medical articles.

Who can keep up with three billion medical articles?

I like to think that I was really just helping out my wonderful cardiologist by passing on to him what I’d Googled about that FDA Drug Alert.

Cell Phones and Health Information Seeking – What Do These 2 Things Have In Common?

[tweetmeme source=”Healthmessaging” only_single=false]Very little…at least among the chronically ill, e.g., the folks who are driving health care use and cost.

An article in AMA News about the latest Pew study on Mobile Cell Phone use caught my eye. The introduction to the article reads:

Despite the proliferation of cell phones in the United States, the number of people using them to access health information is low. But experts believe the sheer number of people using mobile phones and wireless devices means that health information eventually will get more mobile as well.

According to the study, 85% of Americans use mobile phones, but only 17% of cell phone owners have used them to look up health information. 9% of Americans have downloaded a health-related software app on their cell phone.

Get this. The highest use of cell phone health information seeking and downloading cell phone health apps was among 18 to 29 years olds at 29% and 15% respectively. With the exception of accidents, 18 to 29 years old adults are generally among the most healthy demographic. It’s hard to understand, perhaps with the exception of pregnancy and workout sites, why any young adult would be spending on their phone looking for health information. At that age they are immortal for god sakes.

Is it really surprising that so few older adults 50+, half of whom have at least one chronic condition, are the least likely to turn to cell phones to use their cell phone (if they have a smart phone) to seek health information or download health apps (at 6% and 8% respectively)?   First of all who among us over 45 can read the darn screen on their phone without glasses?   And have you ever tried putting on classes while trying to enter text using the phone’s tiny key pad?  It isn’t a pretty site.   Not to mention that most people that age still look to their own physician as the most trusted source of health information.

A Word To The Wise

So before all you health care marketers try and persuade your physician and hospital clients to invest in mobile health management apps or SMS text-based health management programs, consider this simple fact.  Unless you want to talk to health young adults (ok, one day they will get old), the people you need and want to reach don’t seem to be very interested.  But just wait 20 years, as all of today’s 18-29 year olds start to turn 50, and you just may have a market.