April 19, 2014

Doctor–Patient, Communication Needs More Focus

This blog by Nancy Finn is a topic favorite and can really get me wound up. Communication is a term that many dismiss as unimportant in today's medicine. Physicians like the term patient engagement, and other buzzwords to describe one-sided communication and then claim patients do not communicate.

While this is true for many patients who are passive in nature because they expect the doctor to ask the right questions and give all the right medications. Too often these patients are over medicated and given too many unnecessary tests. Communication is a two-way method of making the most of situation and getting quickly to a proper diagnosis. But the failing of today's health care is the lack of effective communication, not only by the doctor, but by many patients as well.

Some of the reasons include:
  1. Many drama kings and queens,
  2. Many cannot concisely explain what is bothering (or ails) them,
  3. Many patients do not have the terms to use (health literacy),
  4. There is too little time with the doctor, and
  5. Many doctors cut the patient short from giving details.

This is sad that in this day and age, with many tools available to doctors and patients for better communications, the art of communication falls by the way-side and is not used. While it is estimated that 80 percent of serious medical errors involve miscommunication between caregivers. This happens in hospitals and between doctors when a patient is referred to another doctor. This is even more complicated now that electronic health records have entered the picture.

It is simplistic if every doctor is an hospital employee and the patient record is open to every doctor in this case. But let an outside clinic become involved and the error rate is back at the 80% level as one electronic health record (EHR) is isolated from another EHR and they are not allowed to communicate. Currently, most patients have no authority to transfer information from one source to another. Most records are HIPAA protected and a doctor or the patient is not allowed to override this isolation even if both agreed. Therefore, the doctor or someone he designates needs to print out the information to be transferred and this is the source of most errors.

Hand-offs is one area where communication has to improve. This is especially true for the elderly being discharged from a hospital to their home or to a nursing facility. The office visit is another. Poor communication is blamed for patient frustration, non-compliance with treatment and medications, and general lack of trust in the physician.  It is said by some that many doctors are interested in their patients and desire to make the right medical decision about medical care.

Doctors do have many distractions, such as continuing education, licensing tests to take, and government and insurer paperwork to complete. The number of required tests and conditions the primary-care doctors need to screen for, has increased dramatically. Then add to this the treatment regimens for chronic diseases like diabetes, heart and lung disease, cancer, and other problems that have become more complicated. These all make the 15 minutes for an office visit more difficult. Little time is available for communication and this puts more pressure on the doctors and unfortunately can cause more diagnostic errors.

Continued in tomorrow's blog

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