Physician Communication with Patients: Research Findings and Challenges

1. Introduction

1 | Introduction What Do We Want in a Physician Visit? What Should We Expect? We all have a good idea of how we want things to go when we visit a physician .We expect—count on—being able to talk to the physician about why we are there. This means telling him or her what feels wrong, explaining why we think prior treatment recommendations are not working, and even suggesting what we think the problem could be or recommending something new to try. We hope that the physician will listen, possibly ask questions that help us clarify our thoughts, and provide new information that could be useful. Most of us hope for some expression of empathy for whatever the problem is that led us to seek attention. We then expect the physician to combine our information with more information collected through tests or an examination and tell us what he or she thinks is wrong. We hope that the explanation is relatively clear and nontechnical, so that we can remember it and respond to the inevitable questions from family members, friends, and coworkers. Finally, we expect that the physician will explain our options and elicit our input about what to do next. That could mean more tests, a scheduled visit with a specialist, a change in lifestyle, or even the news that there is nothing more that can be done at the present time. Again, we hope that the physician will describe these “next steps” or “treatment options” in a way that is easy to understand, with some sympathy for the fact that we may still be thinking about the diagnostic discussion and not listening as closely as we should be. Certainly, we would appreciate it if the physician asked us about our ability to follow the recommendations , given the other demands in our lives, and gave us some sense of what it will all cost. But is this way too much to ask of our physicians ? Are these typical patient “expectations”—or perhaps it would be more accurate to call them “hopes”—too high? Are they unreasonable? Have our physicians been trained to understand and meet these expectations ? Do they have enough time to do so? Some experts would say they that these expectations are not only reasonable but are even necessary if patients are to get the care that they need and the outcomes that they should expect. In 1999, representatives from academic institutions, providers of physician continuing education programs , and leaders of physician organizations met to discuss what they called the “essential elements in physician-patient communication.” They developed a list of these essential elements, which formed the basis for a document called the Kalamazoo Consensus Statement (Makoul 2001). Their consensus statement likely would resonate strongly with most patients today and certainly is consistent with many of the current recommendations for health care reform that are being discussed in the medical community and the public political arena:“The group endorses a patientcentered , or relationship-centered, approach to care, which emphasizes both the patient’s disease and his or her illness experience” (Makoul 2001, 391). The consensus statement described a sequence of “tasks”that the authors believed should characterize physician communication during the physician-patient “encounter” and that, when carried out with competence and empathy, could be expected to improve patient health. They include allowing the patient to complete an “opening statement,” eliciting concerns and establishing a rapport with the patient; using open- and closed-ended questions to gather and clarify information, along with different listening techniques to solicit information; identifying and responding to the patient’s personal situation, beliefs, and values; using language the patient can understand to explain the diagnosis and treatment plan; checking for patient understanding; encouraging patients to participate in decisions and exploring the patient’s willingness and ability to follow the care plan; and asking for other concerns the patient might have and discussing follow-up activities expected of the patient, before closing the visit (Makoul 2001, 391). What Are We Likely to Experience? While these observations about what constitutes exemplary physician communication are sensible and are likely to be intuitively appealing to most patients, numerous anecdotes in the popular media and a growing body of research suggest that the reality of physician communication with patients can fall considerably short of the ideal. Concerns in the health care ‹eld about shortcomings in physician communication certainly are not new. Studies of physician communication have been carried out and Physician Communication with Patients 2 [18...