In the years since the mid-1980s at the height of malpractice lawsuits, several studies have found that doctors who attentively listen to their patients are rated more favorably than those who don’t. Patients who feel their doctors listened to their concerns and took time to discuss treatment options were less likely to pursue a malpractice suit even if they had a legitimate claim.
If communicating is so important, why are doctors and patients so bad at it?
Both sides are to blame. While doctors are under pressure to keep a tight schedule, patients arrive poorly prepared.
General practice doctors are being squeezed by lower insurance reimbursements. Instead of rewarding doctors who take time to consult with their patients, insurers pay more for labs and procedures. As a patient advocate for nearly 20 years, I’ve come to the conclusion that insurance companies could save millions if patients better adhered to their treatment plans — and doctors can better ensure this outcome by taking time to talk with their patients. Instead, family practice doctors must schedule more patients just to keep pace, or for a slight gain in their income. Consequently, their days must function like clockwork, but health care isn’t predictable.
[See: 10 Questions Doctors Wish Their Patients Would Ask.]
If a patient arrives with a complex health issue, the doctor will have to spend more time with that individual, running into the next person’s appointment. The doctor may forego lunch to catch up or stay after hours.
In addition to facetime with patients, doctors try to spend about 10 minutes before and after an appointment reviewing the patient’s health history and then adding notes to the health record.
Meanwhile, patients often arrive feeling scattered as they, too, juggle multiple demands in their harried lives. Once the doctor enters the room, the patient’s mind may go blank, making it difficult to even list one’s prescriptions and supplements.
For years, I’ve been running two seminars for family caregivers and medical professionals entitled “Communicating With Your Doctor” and “Communicating With Your Patient.” Attendees repeatedly comment on how simple it is to prevent a potentially fatal outcome. Over two decades ago, I learned firsthand what can happen when a doctor feels rushed after I underwent outpatient surgery. He gave me partial instructions and didn’t really listen when I asked a question. As a result, I went into septic shock requiring urgent treatment followed by surgery, again.
Doctors and Patients as Partners for Improved Medical Care
So how can we step toward improvement? Doctors and patients who view their relationship as a partnership can achieve better health care outcomes if they follow these suggestions.
Tips for Patients
1. Keep notes of health care issues in between appointments to bring to future visits.
Here’s a helpful way to stay organized. After a doctor visit, create an online calendar entry for the day of your follow-up appointment. If you have not yet set an appointment, create a future placeholder appointment labeled, “Dr. [Name] appointment (unscheduled).”
When you have a health-related question or experience a non-urgent health issue, add a note to that tentative appointment. If you change supplements or stop taking one, include this information, too. After reading something online, if you have a question, include the link right there in the body of the appointment. By the time you set your appointment and are ready to see the doctor, you’ll have all your notes in one place. (You can do this on paper, too, though online calendar tracking can simplify the process.)
If your appointment is scheduled far in advance, this method may yield too many issues to discuss in one visit. In the days before your appointment, or even in the waiting room, prioritize the top two or three most important issues you’d like to cover. It’s helpful to bring a printed copy of these notes to your appointment. You may want to give your doctor permission to scan a copy into your health record.
[See: HIPAA: Protecting Your Health Information.]
2. Take control of the appointment with your doctor.
When the doctor walks into the room and greets you, acknowledge the limited time you have together and ask if you may review the top two or three issues you’d like to cover during the appointment. Doing this may feel uncomfortable at first, but your doctor will appreciate the active role you’re taking in your health care and you will ensure you discuss your most important concerns.
3. Ask questions until you understand.
Research suggests that 25 to 75 percent of patients don’t follow their doctor’s treatment plan. There are no stupid questions. Ask your doctor questions until you feel comfortable understanding the treatment options and their attendant risks and benefits. By discussing your treatment plan, you help the doctor slow down enough to consider your specific situation. If time is short, ask the doctor for resources that you can explore afterward.
4. Toward the end of the appointment, summarize your understanding of the takeaways.
Say in your own words what you’ve learned and ask the doctor to make sure you’ve understood correctly. This is called the “teach-back method.” Don’t leave without a hard copy of any prescriptions or referrals. Despite the efficiency of electronic referrals, a hard copy insures nothing falls through the cracks (assuming you won’t misplace or forget it). Ask for one during your appointment.
Tips for Doctors
1. Take a few moments before walking into the patient’s room to review the patient’s health record.
Better yet, invite your patient to review the notes from the last appointment with you. If you choose this approach, follow the next tip.
2. Greet your patient warmly.
When you walk in the door, smile and maintain eye contact. Your patient trusts you with his or her medical care. Without patients you would not have a viable practice.
3. Offer an overview of how this appointment will proceed.
For example, if you only have 10 minutes, let your patient know: “We only have 10 minutes. Is there anything new you’d like us to discuss after we follow up on the test results from your last appointment?”
4. Invite your patient to tell you the key issue(s) for today’s appointment.
Also make sure to review any treatment plan from the last appointment. If there’s time, move to the next item on your patient’s prioritized list. If the patient brought a hard copy of notes that may be a useful addition to the health record, ask for permission to scan a copy. For protection, ask the patient to write, “Permission for Dr. [Name] to scan a copy for my medical record.” Then have the patient sign and date the copy before scanning.
5. If more time is needed, suggest the patient book a double appointment.
Sometimes, setting a double appointment every year or two will help the patient address his or her health concerns in a comprehensive fashion, allowing time to catch up on any issues that haven’t been fully discussed. Doctors want to help their patients live healthier lives and patients want to be heard and understood.
[See: 14 Things You Didn’t Know About Nurses.]
When communicating in a time-constrained environment, both doctor and patient can partner for better health outcomes by being clear about expectations, being prepared and focusing on the most important issues. In some cases, it can save the patient’s life.
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Patient-Doctor Partnerships: a Recipe for Better Medical Care originally appeared on usnews.com
