It sounds so basic, it is hard to believe it is a persistent problem, yet a recent study revealed that poor communication among health care providers and their patients was the cause of 70 percent of serious adverse medical outcomes in hospitals.
A recent column in The New York Times by a health administrator called on doctors to improve their bedside manner and to listen up. While this is part of the solution, patients also must share their medical history and ask questions when directions and diagnosis are unclear.
“A doctor’s ability to explain, listen and empathize has a profound impact on a patient’s care,” Nirmal Joshi, chief medical officer for Pinnacle Health System in Pennsylvania, said in the column. “Yet, as one survey found, two out of every three patients are discharged from the hospital without even knowing their diagnosis. Another study discovered that in over 60 percent of cases, patients misunderstood directions after a visit to their doctor’s office. And on average, physicians wait just 18 seconds before interrupting patients’ narratives of their symptoms.”
Armed with this data, Joshi’s hospital system in Harrisburg, Pennsylvania, tracked doctor-patient communication (one interesting finding was that doctors introduced themselves to patients only one-quarter of the time) and developed a training system to improve it.
Patient satisfaction with the system’s doctors, as measured through a questionnaire, significantly improved. Joshi notes that studies have found a connection between higher patient satisfaction and health outcomes.
While Joshi puts much of the onus on doctors, patients have a role to play, too. In an anecdote shared in his column, a patient had seen five doctors over the course of a year for a rapid heartbeat. She told the sixth doctor that she was taking an over-the-counter diet medication that contained ephedrine, which is known to raise heart rates. Once she stopped the drug, the rapid heartbeat went away. Asked why she hadn’t told the other doctors, she said she hadn’t been asked.
So, if better communication between doctor and patient makes such a difference, why is it still such a nagging problem?
Dr. Lisa Letourneau of Maine Quality Counts points to many factors. However, the medical payment system, in which doctors are paid per service or procedure they perform, is the major one. This system incentivizes doctors to see as many patients as possible each day with little regard to the health outcomes of those visits.
Under the Affordable Care Act, the federal Centers for Medicare and Medicaid Services have begun reimbursing some hospitals based on performance, not just services provided. Quality is determined through clinical measures and a patient survey called the Hospital Consumer Assessment of Healthcare Providers and Systems.
Locally, Maine Quality Counts, a nonprofit collaborative of health care providers, insurers, employers and community members, has launched a project called Choosing Wisely that encourages patients and doctors to discuss treatment plans and alternatives. It includes five questions to ask your doctor, including whether a test or procedure is necessary and how much it will cost.
These are important initiatives. But it shouldn’t take a poster campaign to encourage patients to speak up and ask questions to ensure they understand their diagnosis and treatment. Nor should it take federal action to get doctors to introduce themselves to their patients and listen to what they are saying.