Patients sometimes are dissatisfied with the communication offered by physicians. “He won’t answer my questions.” “He gets angry with me.” “He cuts me off.” “He won’t answer my calls.” “I can’t understand him.” “He scares me.” Sometimes they say, “You’re the only one who spends time with me.”
Our office schedule allots sufficient time for thorough explanations. In the current medical paradigm, insurance companies, including Medicare, pay physicians less and less for the work they do. Office overhead, however, only goes up. Doctors spend less time with patients because their income depends on seeing more patients. If physicians are employed by an HMO, only a limited amount of time is permitted for each office visit.
New requirements for electronic medical records (EMR) have aggravated the problem. According to reports, doctors now spend more time on the computer than they do with patients. In many offices there is a computer in the exam room, and the doctor focuses his attention on the screen, occasionally looking up to face the patient. The bureaucratic demand for endless documentation has made the situation much worse.
Yet underneath all of this is a more elemental problem. Many physicians have not learned the technology of communication. They should face the patient throughout the time of the visit. They should offer easy to comprehend explanations, then appeal to the patient’s intelligence and understanding, and not try to enforce obedience through fear. Fundamental to effective care is the nurturing of affinity between doctor and patient. The physician should be aware of the patient’s concerns, current stressors, and the family situation.
The physician should use words the patient will understand, and not be too technical. He should provide illustrations of relevant anatomy and procedures. He should define complex terms. Recommendations should be provided in writing, since patients otherwise may not remember what is said to them. Individuals who cannot understand instructions are unlikely to follow them. We should simplify our language.
It is also important to understand the patient’s point of view. A patient may have an intense fear of surgery or anesthesia, whether justified or not. Some individuals prefer to risk the consequences of their disease rather than the side effects of medications or the complications of surgery.
My purpose is to offer knowledge, experience, and judgment. It is up to the patient to decide what course he will choose. If I disagree I will say so. Throughout all discussions it is crucial to maintain affinity. Otherwise the communication line will wither.
Medicine in my lifetime has made astounding advances in knowledge and therapy. It has lost some ground in the practice of communication.
We need to rediscover the virtues of the old-time doctor-patient relationship. Have a doctor you can trust and who listens to you and talks to you.
Dr. Allan Sosin