Monday, August 16, 2010

Communication Gaps Between Doctors and Patients

In a surprising report from the Archives of Internal Medicine, we learn that most hospitalized patients (82%) could not accurately name the physician responsible for their care and almost half of the patients did not even know their diagnosis or why they were admitted.  If that isn't enough, when the researchers queried the physicians, 67% thought the patients knew their name and 77% of doctors thought the patients "understood their diagnoses at least somewhat well".  I would call that a pretty significant communication gap!

Ninety percent of the patients said they received a new medication and didn't know the side effects.  Although 98% of physicians thought they discussed their patient's fears and anxieties with them, only 54% of patients thought they did.

The researchers from Yale University School of Medicine and Waterbury Hospital concluded: “Significant differences exist between patients’ and physicians’ impressions about patient knowledge and inpatient care received.” Moreover, responses didn’t significantly differ by sex, age, race, language or payment source, for the patients, or level and type of training, for the doctors.

A great deal of evidence exists that shows patients who understand their condition, are educated about medication and have good rapport with their physician have better outcomes.  It is just common sense.  I know that medical schools teach interpersonal relationships and the fact that so many physicians think they are doing it right makes me wonder how they can be perceived so differently by the patients.

Some possible explanations are:
  • Patients are stressed while hospitalized and do not remember what is said.
  • Many patients are heavily medicated and that affects ability to learn and remember.
  • Doctors are too rushed and deliver information too quickly to be understood.
  • Hospitalized patients have too many consultants and no one is identified as the "responsible physician".
  • The trend to get patients out of the hospital quickly short changes communication time.
  • Nurses, consultants and hospitalists don't communicate well together and the patient gets a different message from each visit.
There may be many other potential reasons.  Everyone in medicine should take a pause to look at this study very carefully because it shows so much room for improvement.

28 comments:

Michael Kirsch, M.D. said...

This is very provocative information. As in medicine, making the diagnosis is easier than finding an effective treatment. Nevertheless, this communication gap should be solvable, but there are many obstacles before us, as you have outlined. Perhaps, there are hospitals that have a very narrow gap that can offer lessons to the rest of us.

Have Myelin? said...

Sometimes I don't think peeps listen to each other.

I can't get my medical records from my previous neuro (she won't release them, yes I know it's my 'right', still battling her for them) but I did get the ones from 2007 from Voc. Rehab.

Nothing crazy in there but I was dismayed to find out that things I reported turned into something else.

For example I told her I thought I had a seizure in which my tongue was bitten (I broke a tooth in this undiagnosed 'event') and she wrote "patient complaining of swollen tongue and full body spasm".

Full body spasm? I didn't say my tongue was swollen. I said it was bitten, tooth broken- point I was trying to make was, something happened. I don't know what since I 'wasn't there' since I was kind of out of it. To this day I don't know what happened but it sure wasn't a full body spasm! LOL.

You have a great blog by the way.

Toni Brayer, MD said...

Have Myelin?: What a compelling story that shows how facts can become so altered and appear in the medical record. I know this happens all the time but I do not know the fix. Certainly when patients can "see" and correct the record that can help. thanks for writing.

melissa said...

i agree with this. i was hospitalized for a week but when i got discharged, i was not even sure what my diagnosis was.i think having to many doctors come in and out of the room can get pretty confusing from the patients perspective.

cheska said...

It could be as simple as, the two parties (patient and physician) being in two totally different wave lengths while they are engaged in their conversations. It could be a simple matter of physicians bringing their level of conversation at par with the patients level of understanding.
Communication, i have to say, and most of you might agree, is a highly essential part of a patient's treatment. Can you imagine undergoing treatment without understanding what you're about to go through? Sounds frustrating, in fact, borderline torturing for me.

Have Myelin? said...

Toni, I had a neuro-ophthalmologist when I had Optic Neuritis who was also a Professor at the medical school. He had a very interesting way of handling medical charts.

Each exam room had a laptop. He began each visit by saying, "Let me gather information for your chart". During each visit, he typed while you spoke. He did maintain eye contact but his focus was on gathering info.

Then he'd do his eye exam and updated his notes as he went. I thought he was fabulous.

Here is what made him very different. When we were done, he gave me a copy of the notes off the network printer and said "When you get home, please review clinical notes, prescriptions, and if there are any questions, please call xyz at xxx-xxxx because we must correct your chart."

I thought goodness? It was very helpful, as it turned out.

He did that everytime I saw him. When I mentioned I was moving to another state, he said "You still have your records, don't you?" I wanted him to say goodbye, not THAT! LOL. =p

Funny man.

AbhayaMedia Health said...

Indeed, this shows a communication 'gulf' between doctors and patients. It is no wonder that wrong diagnosis and treatments are common in many hospitals. At least this study can help administrators and overloaded doctors to realize the blunder that this 'gulf' can cause at the cost of patient's health and safety.

Anika said...

It is good to read those explanation regarding patients.I can say that you have written true here and I do agree with your points about communication gaps between Doctors and Patients.

BrainDame said...

Thanks for bringing this study to light-there is a gap (whether it is as bad as this article suggests or different) and the sooner this is recognized, the better we can addressthe challenges it creates.

Paul Dorio said...

Great blog. Great topic. Great comments.

# Doctors are too rushed and deliver information too quickly to be understood. ---> ABSOLUTELY
# Hospitalized patients have too many consultants and no one is identified as the "responsible physician". ---> ABSOLUTELY x 10

As a specialist (interventional radiologist) I can't tell you how often it is that I see patients in consult who tell me that there doctor "didn't tell them anything." I've come to realize through discussion with many of those referring doctors, that they of course did communicate some/all relevant information. There is obviously a disconnect between what a patient hears, what a doctor says, what a doctor hears, and what a patient says. -- As exemplified by "HaveMyelin?"

I think the problem is partly that most doctors no longer know how to communicate using "normal English." I remember being criticized by my OB attending (first rotation in med school) for not using medical terms enough when talking with my patients. ---- I took that as a compliment!

I think the key from the doctor's standpoint, is to pay extremely close attention to what we say, how we say it, and how the patient responds. Then we can be better assured that we have had a fruitful communication.

Steve said...

The "communication gap" you described is not just a challenge for hospitalized patients. It is also a chronic problem in the physician's office.

Quoting from a 2006 Archives of Internal Medicine article by Tarn, D.et. al., during visits in which a new medication was prescribed, adverse effects were addressed
by physicians for 35% of medications and how long to take the medication for 34%. Physicians explicitly instructed 55%
of patients about the number of tablets to take and explained
the frequency or timing of dosing 58% of the time.

No wonder patients are adherent...

Steve Wilkins, MPH
http:\\www.healthecommunication.wordpress.com

emmy said...

Recently my daughter-in-law was intensive care at a teaching hospital with DKA. The attending would speak to whatever family member was available and what he said would not be accurately reported to any family member who came in later. Then as different fellows came in and out they would disagree with what the attending or the other fellows had told us and propose their own thoughts about what was wrong. One even told us that he disagreed that Jenn is diabetic. After he left Jenn's mother politely asked the nurse to have him removed from Jenn's care. With so many opinions flying around it was hard for us to get a good idea about anything. It also made us distrustful of her caregivers. Thank goodness the nurses were wonderful and came behind the residents and fellows and explained what was really happening.

kumara said...

Great thoughts you got there, believe I may possibly try just some of it throughout my daily life.

doctors online

lala said...

Thanks for your post and welcome to check: here
.

linkwheel said...

Hey cool weblog, just questioning what anti-spam software program you employ for feedback as a result of i get heaps on my blog. Anyway, in my language, there usually are not a lot good source like this.

link wheel said...

I was looking for crucial data on this subject. The information was vital as I'm about to launch my very own portal. Thanks for providing a missing hyperlink in my business. Anyway, in my language, there aren't a lot good source like this.

sim so dep said...

oh coo, this information is really useful and definately is comment worthy! hehe. I?ll see if I can try to use some of this information for my own blog. Thanks!

so dep said...

Your weblog is fine. I simply need to comment on the design. Its too loud. Its doing method too much and it takes away from what youve got to say --which I feel is admittedly important. I dont know if you happen to didnt suppose that your phrases may hold everyones attention, however you have been wrong. Anyway, in my language, there usually are not much good source like this.

sim so dep said...

Full body spasm? I didn't say my tongue was swollen. I said it was bitten, tooth broken- point I was trying to make was, something happened. I don't know what since I 'wasn't there' since I was kind of out of it. To this day I don't know what happened but it sure wasn't a full body spasm! LOL.

muebles la rioja said...

This will not have effect in reality, that is what I believe.

sim so dep said...

He did that everytime I saw him. When I mentioned I was moving to another state, he said "You still have your records, don't you?" I wanted him to say goodbye, not THAT! LOL. =p
Funny man.
sim so dep

www.mueblesencorbera.com said...

This can't work in reality, that's what I think.

sim so dep said...

Howdy, i learn your weblog often and i personal an identical one and i used to be just wondering in case you get loads of spam comments? If so how do you forestall it, any plugin or anything you possibly can advise? I get a lot lately it's driving me mad so any assistance is very a lot appreciated. Anyway, in my language, there aren't much good supply like this.

sim số đẹp said...

I was very happy to seek out this site.I wanted to thank you for this great learn!! I undoubtedly enjoying every little bit of it and I have you bookmarked to check out new stuff you post. Anyway, in my language, there aren't a lot good supply like this.

sim số đẹp said...

I was very happy to seek out this site.I wanted to thank you for this great learn!! I undoubtedly enjoying every little bit of it and I have you bookmarked to check out new stuff you post. Anyway, in my language, there aren't a lot good supply like this.

Sim viettel 10 so said...

There are actually plenty of details like that to take into consideration. That may be a great level to convey up. I provide the thoughts above as general inspiration but clearly there are questions like the one you deliver up where crucial factor will likely be working in honest good faith. I don?t know if finest practices have emerged round things like that, but I'm sure that your job is clearly identified as a good game. Anyway, in my language, there are usually not a lot good source like this.

Sim viettel 10 so said...

Can I make a suggestion? I believe youve received one thing good here. However what if you added a couple links to a page that backs up what youre saying? Or perhaps you might give us something to look at, something that would join what youre saying to something tangible? Only a suggestion. Anyway, in my language, there will not be a lot good source like this.

Sim viettel so dep said...

I used to be more than happy to search out this site.I wished to thank you for this nice read!! I definitely enjoying each little little bit of it and I've you bookmarked to take a look at new stuff you post. Anyway, in my language, there aren't a lot good supply like this.