Physician Communication with Patients: Research Findings and Challenges

2. What Is the Evidence That Physician Communication Is Deficient?

2 | What Is the Evidence That Physician Communication Is Deficient? Anecdotal evidence, supported by the results of consumer surveys (Blendon, Buhr, et al. 2003), suggests that poor physician communication is pervasive in America and in other countries as well. The need for research to document its existence likely would seem questionable or even mildly amusing to most patients and health care providers. Conventional wisdom also seems to support the notion that poor physician communication can result in patients being dissatis‹ed with their physician consultations , inadequate care, missed opportunities to improve patient health, and, possibly, poorer health. However, even if true, these general assumptions by themselves provide little guidance in how to improve patient communication. In this chapter, we review and summarize the published literature on the existence of poor physician communication. (In chapter 3, we address the impacts of poor physician communication on patients.) We here draw conclusions regarding where the research is strongest relating to the existence of physician communication shortcomings; that is, we ask for which of the “essential elements” of physician communication that were described in chapter 1 has poor physician performance been established the most convincingly? This information is critical to the targeting of efforts to improve physician communication. For instance, if there is not a strong research basis for concluding that physicians perform poorly in collecting the information they need to form accurate diagnoses, the case for new efforts to improve physician interviewing skills must rest largely on intuition , rather than evidence. In contrast, if there is strong evidence that physicians are poor at exhibiting empathy toward their patients, implementing programs to train physicians in how to do this more effectively might be warranted. In this chapter, we summarize research ‹ndings related to the afore17 mentioned issues. First, we provide an overview of the existing literature, organized by areas of potential communication de‹ciencies addressed in individual studies and by practice type or setting in which data collection occurred. Then, we summarize the research evidence regarding the existence and nature of poor physician communication. In summarizing the evidence, we present article ‹ndings in the tables at the end of the chapter and discuss selected individual studies in the text to illustrate the nature of the overall ‹ndings. In the concluding section of the chapter, we interpret our ‹ndings with respect to their implications for improving physician communication. Identifying Relevant Literature We searched the literature to identify peer-reviewed papers published in English that were relevant to the research questions in this chapter. We searched Medline, JSTOR, and the databases of the Cochrane Library and the Agency for Healthcare Policy and Research (AHRQ) for review articles and individual studies (not contained in review articles) published from 2000 to 2008. While review articles sometimes were limited to particular aspects of physician communication, the individual articles contained summaries of past work as well. We combined these sources of information to provide a historical perspective on physician communication, as well as more detailed information regarding selected , recently published studies. We used a combination of such keywords as “physician-patient relations ,” “communication,” “quality of health care,” “palliative care,” “empathy ,” “patient participation,” “treatment outcome,” “patient-centered care,” and “outcome assessment (health care)” to identify studies for inclusion in this chapter and in chapter 3. We constructed a database containing the articles identi‹ed in the search process. Our search process was designed with broad inclusion criteria. We included studies employing a variety of methodologies, focusing on many different medical conditions , and set in different countries. The initial search yielded over 1,100 references. After eliminating articles not directly related to physician communication, we reviewed over 300 articles or abstracts. In many cases, evidence relating to poor physician communication was found in the context of broader studies of communication in health care. We did not include studies related to poor patient communication or patient health literacy unless they had a substantial component directed at physician communication issues. Physician Communication with Patients 18 What Is the Evidence Regarding the Existence of Poor Physician Communication? Our search process generated 8 review articles and 58 individual studies (not included in the reviews) that addressed evidence that poor physician communication exists. As indicated in table 2.1, 18 of the 58 individual studies were carried out in clinical settings related to specialty outpatient care, with 8 of these studies focusing on cancer treatment. Another 5 studies combined primary care and specialty care settings...