Nancy B. Finn's Blog
September 5, 2011
Communication, A Challenge to Participatory Medicine
Participatory medicine depends on the availability of health information to all members of a care team. Communication or the exchange of thoughts, opinions, or information by speech, writing, video or signs that include body language continues to be a hotly debated, difficult to execute practice in healthcare. There have been multiple studies over the years that reinforce the correlation between good communication among patients and providers and improved health outcomes. For example in an article, entitled: Effective Physician-Patient Communication and health Outcomes, a review of 21 studies, By: M A Stewart, Thames Valley Family Practice Research Unit, Centre for Studies in Family Medicine, University of Western Ontario, London, the findings revealed that 16 reported positive results, 4 reported negative (i.e.,nonsignificant) results, and 1 was inconclusive. Among the key conclusions is that the quality of communication both in the history-taking segment of the visit and during discussion of the management plan was found to influence patient health outcomes. (CMAJ-JAMC listed in Pub Med, (CMAJ 1995 May 1: 153(9) 1423-1433 PMCID PMC 1337906). www.ncbi.nih.gov/pmc/articles/PMc1337906/
This would reinforce the contention that health information gathered from patient interviews, face-to-face exams and other communication between providers and patients, such as email or e-visits play a key role in treatment decisions, ongoing health monitoring, adherence and results.
Low expectations regarding teamwork and communication have for many years encouraged a culture where teamwork and collaboration are difficult to achieve. It's ironic that ever since the publication in 2000, of the original IOM report, To Err Is Human, healthcare organizations have worked hard to improve patient systems and patient safety but most have failed to address poor communication habits that would enhance information sharing. It is clear that when health care professionals do not know what their colleagues are doing to manage a patient they are seeing, and when patients do not have the opportunity to share the information held by their providers, all the patient safety rules in the world cannot compensate.
During the past 25 years there has been a lot of talk about the need for training medical students in communication skills. It was not until June, 2004, that a communication skills component was added to the U.S. Medical Licensing Exam to test medical students on their ability to gather information from patients, perform a physical examination and communicate their findings to patients and colleagues.
The Agency for healthcare Research and Quality has developed CAHPS, (Consumer Assessment of Healthcare Providers and Systems) a public-private initiative to develop standardized surveys of patients' experiences with ambulatory and facility-level care.
CAHPS also publishes guidelines for patients to help them understand the important communication skills they need to improve their ability to share information with providers. These guidelines include four areas:
1. Record Sharing- patient access to the electronic health record
2. Patient Question Lists – what to ask the doctor at a typical visit
3. Feed Forward – a questionnaire filled out by the patient prior to receiving care
4. Coached Care- teaching patients how to ask the right questions and be more assertive during a face-to –face visit with their physician
Unfortunately not many patients know about these guidelines or access them. Health care consumers are inherently well-equipped to judge the ability of their clinicians to communicate with them effectively. Many healthcare organizations including hospitals and health centers now strive to enforce good communication habits among their physicians and encourage their patients to participate in their care and collaborate with their providers. Many payers also work with enrollees to help them understand communication skills needed in their increased participatory role. As e-Patients become more invested in the partnership model they have to work at communicating with their providers. It is a two-way path where several things must happen:
1. Both patients and providers must improve their willingness and ability to share information.
2. For providers it begins with medical school training where a required course in communication skills should be mandatory. Additional communication skills training should be included in residency programs.
3. Providers also need to be more diligent about being absolutely sure they have full information on a patient at the point of care.
4. Patients need guidelines regarding when and how to ask questions, be aggressive and speak up when they do not understand an explanation. They need to understand that there is no question too trivial to ask their provider when they are confused or unclear about a condition, treatment or medication.
5. Payers need to initiate and support programs that help providers and patients communicate more effectively so that some of the inefficiency and errors in medical care will be eliminated, saving time and money.
There is no industry where communication is not an essential component to keep things running smoothly and efficiently. In healthcare, however, communication can save lives and that is beyond essential.
Nancy B. Finn Author, e-Patients Live Longer, The Complete Guide to Managing Your Health Using Technology
