Doctor-patient communication: A shared responsibility

Your body is yours alone, but you share responsibility for your health with your doctor. It's true for healthy people, who should collaborate with their physicians to plan a program to prevent illness. And when people become ill, sharing is even more important. The doctor certainly shoulders the major responsibility for establishing a diagnosis and planning a treatment. But for the treatment to work properly, the patient must understand his illness and follow the treatment plan responsibly.

Communication is the answer. Patients must convey their symptoms and concerns, and doctors must explain their diagnoses and treatment. It sounds simple, but a study shows that the chain of communication can have some mighty weak links.

The numbers speak

To find out how well people understand their diagnoses and treatments, doctors in New York surveyed patients when they were discharged from the medical service of a teaching hospital. To be eligible for the study, the patients had to have a good command of English and be alert, oriented, and able to understand the researcher's questions. They were allowed to supplement their memories by referring to their notes or other written material.

Although the New York State Patients' Bill of Rights specifies that all patients should "receive complete information about their diagnosis, treatment, and prognosis" and that they should be able to "participate in all decisions about [their] treatment and discharge from the hospital," only 42% of the patients were able to state their correct diagnosis in medical or everyday language. Only 28% could list their medications by trade or generic name, even though the average patient in the study received fewer than four medications on discharge. Whether or not they knew the names of their medications, 37% of patients did know their general purpose, but only 14% could state the common side effects of their pills.

The study involved only 47 patients from one hospital, and it did not explore the possible harmful effects of this insufficient knowledge. But earlier studies from the United States and Britain have reported similar findings; in fact, a 1993 estimate placed a $100 million annual price tag on the problem of inadequate patient understanding and compliance.

Just as health is a shared responsibility, improving communication and understanding is also a task to be shared by doctors and patients.

What doctors can do

Physicians should remember that the word "doctor" is derived from the Latin docere, "to teach." Today's physicians should be educators, teaching patients about their bodies, their illnesses, and tests and treatments. That means spending time with patients, having staff members assist in patient education, or both. It means using clear, straightforward language suited to each patient's educational and cultural background. Unfortunately, many doctors tend to speak "medicalese," technical jargon. They should know better; many centuries ago Hippocrates said, "The chief virtue that language can have is clearness, and nothing detracts from it so much as the use of unfamiliar words."

Clear words are necessary, but they may not be enough. Whenever possible, doctors should offer patients written information or referrals to appropriate print or Internet resources.

Physicians must avoid common pitfalls. All too often, an encouraging word — "Your blood pressure is doing great" — is misunderstood as an invitation to stop taking the very pills that are doing a good job. And simply reciting a drug's possible side effects without indicating which are rare or reversible is likely to scare a patient away from even filling his prescription.

Above all, perhaps, a doctor should encourage his patients to ask questions and should ask them to repeat essential instructions and precautions. It's an important goal; unfortunately, it requires a precious commodity that's being threatened with extinction by the demands of modern medicine: time.

What you can do

The more you know about your body, the better you'll understand your doctor's explanations and instructions. Be an informed health consumer. If you keep up with major developments in medicine, you'll be able to get the most from the time with your doctor.

Before your appointment, make a list of your concerns so you'll be sure to mention them. Your doctor may wince when he sees the list, but he'll appreciate your efficiency. And pull out a pencil with your list so you can jot down important facts and instructions.

Ask questions. Remember, there is no such thing as a stupid question (though there are stupid answers). Don't be afraid to ask your doctor to rephrase or repeat anything that isn't clear the first time. Ask for pamphlets or other instructional material. Set a time for a second conversation, whether in person, on the phone, or by e-mail. And if you anticipate a discussion of important issues, consider taking along a relative or friend for support as well as an extra set of ears.

When you are discharged from a hospital, you will usually receive instructions from a nurse as well as a doctor; physical therapists and nutritionists may also provide information. In the office, too, you may be able to review things with a nurse as well as your doctor, and your pharmacist can provide information about your medication. But you can get too much advice. Be sure your providers all agree, and ask for clarification if they seem to be in conflict.

Keep your own medical history. Include major illnesses in your family, major events in your health, a list of your medications (past and present), and a list of any bad drug reactions. This information will help you when you talk to any new doctors or specialists.

Prospects

The information age is offering new methods of communication at a staggering rate. But it's also bombarding doctors and patients with a staggering amount of information. We all have to learn new ways to acquire, organize, and store that material. We also have to maintain the irreplaceable basics: an open, honest, trusting doctor-patient relationship and the time needed to ask questions, get answers, and assimilate information. Even in the electronic era, that's communication at its best.