Saturday, April 29, 2006

Prognosis good communication

In a couple of weeks, I'm due to see a new medical specialist. I had to, I simply could not persevere with the one I was already seeing. The doctor in question did not like me to ask questions about my diagnosed health conditions, dismissed the concerns of my primary health care doctor and another specialist (as told to me), refused requests for a consult from other specialists when I was an inpatient (again, as told to me) and was often rude and abrupt. Now, the last two I can handle. After all, I'm only looking for good medical care and not a new best friend but the other matters..well, much as I hate changing doctors, what choice do I have?An excellent doctor but obviously we didn't have a good working relationship and we're probably both to blame for that.

So it was interesting to see a BBC news story (UK) concerning a study undertaken by the Picker Institute, a medical research company, examining data from six international surveys of the extent to which health professionals are supporting patients to become more involved in their own healthcare. The report showed that what people want from their health professionals is good communication, respect for their preferences and support in helping them to help themselves.

Good news for some of us, bad news for Britons. The UK lagged behind Australia, Canada, New Zealand, Germany and the US in enabling the individual to play a more active role in their own healthcare. In particular, the report drew attention to the 'paternalistic attitude' of UK health professionals. British individuals were less likely to be given information about their conditions or be involved in treatment decisions.

It doesn't surprise me. I am British and the comments I hear from family members in the UK tell me little has changed in the years I have been away. My experiences in Australia have been largely different. Most doctors are welcoming of a patient who takes an active interest in their health management. Most are more than happy to take time to explain things and clarify options according to their patient's preferences. After all, some people prefer to have less information and personal involvement.

So what went wrong in my scenario?

Poor doctor-patient communication

Well, this isn't intended as an exercise in doctor-bashing. Good medical care is a partnership and both parties are usually at fault.

The medical side of the equation

One of the major problems is simply a failure to listen. In an attempt to manage the interaction, doctors frequently interrupt their patients. While understandable from the point of time constraints, this can result in the loss of potentially significant information.

A second major problem is the use of medical jargon. My previous general practitioner was always using complex medical terms that went straight over my head but I'd remind him, he'd explain and then we'd laugh about it. Some simply forget, it's simply what they're used to, the cynics amongst us might suggest jargon may be used to dissuade the patient from asking too many questions. Blinding us with science!

Of course, sometimes things can go in the other direction and the language used can be overly simplistic. I'm afraid I don't appreciate talking about my "tummy". You get my drift. In a stress-inducing situation, such childish talk can make the individual feel even more helpless.

Balance. It's a word I use a lot. The truth is most of us prefer our information to be delivered to us somewhere between the two of these extremes.

There are other issues but I consider these the main bones of contention.

You can read a summary of some of the key research here.

The patient side of the equation

Being a patient can be anxiety provoking, particularly when experiencing strange and worrying symptoms. Anxiety can make it hard to concentrate and take in what's being said. It might seem like we're not listening and that can be frustrating for the doctor.

Also, we can often give doctors misleading information about our true concerns. Sometimes, fearing the worst, patients may downplay a key symptoms as unimportant or, worse still, fail to mention it. Similarly, they may fail to ask questions because they're worried about what they might hear in response. In these situations, in the absence of ESP, it can be very hard for the doctor to work out what's going on.

The benefits of good communication

People often have more confidence in their health care when they are informed and can exercise some choice in what happens to them. This increased confidence means they are also more likely to adhere to advice or treatment given to them.

What can we as patients do to facilitate it?

Again, a good doctor-patient relationship is a partnership. Doctors are often busy and time-pressured. Building a good relationship means taking into account the demands on your doctor and putting in some effort yourself to maximise the benefits you can achieve from his or her time.

Be prepared for the appointment

Be able to list your current symptoms, current medications and past medical history, if required. Mention anything that has changed since your last appointment.

Because people can often forget what they are told during a medical consultation, take a pad, be ready to make notes. Some people even tape consultations but, note, this requires the prior approval of your doctor.

Communicate your health concerns

Remember your doctor's time will be limited. If you are experiencing a number of problems, prioritise and start with the most important one.

If you are feeling embarrassed or worried about the examination, tell your doctor. Be honest about your situation, don't simply say what you think the doctor wants to hear. Quit smoking yet? Of course! Hmm. Your doctor needs the truth.

Mention any non-health concerns that may be affecting you.

Ask questions

If your doctor says something you don't understand, ask the doctor to explain in simpler terms. Doctors are used to complex medical terms, they sometimes forget this when dealing with lay people.

If you would like more information about your condition, ask the doctor to elaborate or if he or she can direct you to a reliable source of information. Many health conditions have associated support groups.

And if it's still an issue..?

Then maybe you're in the same situation as me and you've just simply got to consider finding someone else more prepared to work with you.


Goepp-Watch said...

This is a great post. You got some bad care! Good luck with the new provider. Healthcare providers should never forget that the primary duty for patient is to collaborate with them in the management of health and well-being.
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Dr. Deborah Serani said...

It is a strange experience when I ask about things or want certain tests explored because of my family background. Instead of being met with a positive response, I often receive, "Why do you need to know why I chose this for you.... or Why is that test necessary?" I have moved from many a doctor who does not allow me to think and question and advocate for my own health. Especially since the average visit in the US is 4 minutes per patient.


healthpsych said...

Hi Goepp-watch,
Thanks. Read your post, interesting but I'm not sure I could add anything useful!

Hi Deborah,
At least we have the freedom to change doctors when things don't work out, I guess, compared to some places with a more restricted health care service.
It's disheartening that you get questioned for requesting a test given there are reasonable grounds for it ie. family history. That really makes no sense to me at all.

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ClinkShrink said...

One other thing you might add to your list for improved communication:

Bring a friend, family member or other loved one to an appointment.

We usually think about this in terms of geriatric patients---assuming older folks may not always remember their history correctly---but the fact of the matter is that anyone could forget to mention something during the course of an appointment, or be too anxious to ask the right question at the right time.

I'm enjoying the blog. Keep it up.