Physician-Patient Communication Major Factor in Each Encounter, Studies Show
A physician’s bedside manner significantly impacts patient and client satisfaction, especially in states where workers lack the choice of their medical provider. Determining the extent to which patient choice influences perceptions of treating providers is challenging. Acknowledging difficulties in obtaining unbiased patient satisfaction data in occupational health settings, the National Association of Occupational Health Professionals is collaborating with Press Ganey to create a tailored satisfaction survey for internal and external comparisons. A draft survey from the NAOHP’s Benchmarking Committee was discussed at RYAN Associates’ recent annual National Conference in Atlanta, with suggested changes forwarded to Press Ganey’s research scientists for review. Pending approval of an agreement between NAOHP and Press Ganey, a final version of the satisfaction survey is anticipated for NAOHP members in 2012.
Communication is Critical
Studies show that physicians with lower-than-average patient satisfaction ratings receive more patient complaints, have more risk management encounters, and are more likely to be sued. In one study, physicians in the middle third of ratings had 26 percent more lawsuits, while those in the bottom third had 100 percent more lawsuits. While poor bedside manner is a concern, it is not as serious an offense as ineffective communication practices among providers that can result in serious incidents and even patient deaths. According to studies conducted by The Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations or JCHAO), for example, communication failures are a leading cause of medication errors, delays in treatment, and wrong-site surgeries. In the past three years, poor communication has been listed as the third most cited cause of sentinel events, which typically have multiple root causes. In 2010, leadership and human factors were ranked above communication as leading causes of sentinel events, and in 2008 and 2009 assessment and care planning were cited as the number one and two causes of sentinel events, respectively. In a widely publicized 2001 survey, the Commonwealth Fund found that doctor-patient communication often fell short: One in five American adults had trouble communicating with their doctors, and one in 10 felt they had been treated disrespectfully during a recent healthcare visit. Meanwhile, a newly published study suggests that even a seemingly minor explanation by the treating physician can improve outcomes. In the study, Lynne Robins, Ph.D., of the University of Washington, and colleagues analyzed audiotapes of 263 patient visits to 33 physicians providing care to adult patients in eight community-based, university-affiliated primary care practices. Communication was defined as “transparent” if the physician used nine types of conversational phrases. Some phrases communicated the process of the clinical encounter, such as what will be included in the visit or stages of the physical exam.
Other phrases clarified the medical content of the visit and demystified medical terms and jargon or focused on the patient’s subsequent course of action, such as how to take medication. Physicians spent the greatest amount of time during the encounter explaining medical terms. Other types of transparent communication often included sharing emotions and judgments about the patient’s condition, giving reasons for treatment rationale, and orchestrating instructions on taking medications or determining the next appointment. Patients prompted their physicians to be more transparent, but relatively infrequently. They averaged around one prompt per visit to ask for clarification about medical jargon. In half of the visits, patients asked their physicians to share their thoughts. Patients only infrequently asked for additional information about treatment and diagnosis. The researchers concluded that “proactive transparency appears promising to increase understanding and collaboration.” They go on to state: “In patient-centered care where collaboration is the ideal, transparency in its various forms is a critical ingredient. Without much communicative effort, physicians who proactively communicated that an examination was over, that they were leaving the exam room briefly so patients could dress provided information that appeared to address patient uncertainty and demonstrated empathy and respect.”.
Question-Answer Initiative
The transparency study was supported in part by the Agency for Healthcare Research and Quality (AHRQ), which recently launched an initiative to encourage clinicians and patients to engage in more effective two-way communication to support safer care and better health outcomes. The initiative serves as a reminder that communication is a foundational principle in occupational medicine practice. Building on prior public education campaigns the agency has conducted under contract with the Ad Council, the theme is Questions are the Answer.
The Q&A initiative features public service ads directed at clinicians with the message that a simple question can reveal as much important information as a medical test. Research shows that better communication correlates with higher rates of patient compliance with treatment plans, such as better blood sugar control for employees with diabetes.
“We know that when patients and clinicians communicate well, care is better. But in today’s fast-paced health care system, good communication isn’t always the norm,” said AHRQ Director Carolyn M. Clancy, M.D. “Effective communication between patients and their health care team is important and it is possible—even when time is limited.”
In an online advice column, Dr. Clancy noted: “Our health care system is very busy and often confusing. As a result, communication between patients and clinicians is often interrupted. Even when patients have a lot of questions, the average time for a doctor’s visit is often less than 20 minutes,” according to studies.
The communication initiative also features:
- Customized notepads for medical offices and clinics to help patients identify the top three questions to ask during their medical appointments.
- A website with an interactive “question builder” tool that helps patients create, prioritize, and print a personalized list of questions based on their health condition.
- A brochure, Be More Involved in Your Health Care: Tips for Patients, offers steps to follow before, during, and after a medical visit.
- A series of videos featuring patients and clinicians discussing the importance of asking questions and sharing information. Several patients discuss how good communication helped them avoid medication errors or get a correct diagnosis. Clinicians stress the benefits of having their patients prepare for medical appointments by bringing a prioritized list of questions they wish to cover.
A Training Option
Meanwhile, the Institute for Healthcare Communication (IHC), an independent organization focused on enhancing healthcare quality by improving communication between clinicians and patients, reports it has provided training to more than 160,000 physicians and other healthcare professionals in North America since its inception in 1987. According to the IHC, a clinician may conduct as many as 150,000 medical interviews during a typical career, making the interview the most common “procedure.” However, communication training for clinicians and other health care professionals historically has received far less attention than other clinical tasks, even though a growing body of evidence suggests that a structured approach to communication measurably improves health care delivery. In addition to improving patient compliance, research shows that a physician’s ability to explain, listen, build rapport, and empathize can have a profound effect on patient satisfaction and confidence and that improved communication is an important step toward better results in the areas of preventive medicine, therapeutic behavior change, and long term self-management of chronic illness – all critical issues when managing the health of a working population.
“In consequence, doctor-patient communication, once treated lightly as mere ‘bedside manner,’ is now considered an important practical skill,” the institute reports.
