How to Communicate Effectively with Your Doctor: Working Toward Informed and Shared Decision Making

Treatment results improve when doctors and patients collaborate in medical decision-making. Such was the conclusion of Dr. Jane Harrington, of University College London in a January 2004 meta-analysis.1 Dr. Harrington critically examined 25 papers that studied how improving the quality of doctor-patient communications affected patients’ level of satisfaction with their care and their response to treatment. In each of these studies, patients were provided with sample questions to ask their doctor, informative essays or brochures, or videotaped examples of communication techniques to use as preparation for a doctor’s appointment. In most of these studies, efforts to help patients more effectively communicate with their doctors resulted in increased patient satisfaction, an increase in the amount of questions asked and information received, an increased feeling of control over one’s health, better compliance with treatment recommendations, and better overall health outcomes.With all the emphasis on technology in today’s medicine, it is encouraging to note that quality human interaction can still influence the effectiveness of medical care. In this article, the second in our Becoming Your Own Advocate series, we present suggestions to help enhance preparation for medical consultations and offer some specific questions to ask your doctor. We also include findings from recent research that may help dispel common myths about the clinical encounter and the ways in which doctors and patients truly interact.

Why Work to Improve the Doctor-Patient Interaction?
There are many situations in which the combined judgment of two people – specifically the patient and doctor – is not only helpful, but required. If two medical studies offer contradictory recommendations or if a patient is in a situation where there is no known effective treatment strategy, quality communication between patient and doctor is essential to arrive at a viable solution and course of action.

Why Do Your Homework?
Many studies have found that higher levels of health literacy on the part of the patient are usually associated with both better quality patient-physician communications and better individual health.2 And the better that communication is, the deeper the patient’s understanding of his or her own condition, which can lead to better treatment outcomes.

Is it Possible to have Better Communication in a Ten-Minute Consultation?
Seven studies reviewed in Harrington’s meta-analysis looked specifically at whether measurable improvements in communication could be realized without increasing the amount of time spent. Five of these seven studies found that patients who used more effective communication strategies were more satisfied with their consultation – and had opportunity to ask more questions – even though the consultation length was not increased.1, 3, 4 This should be reassuring to doctors concerned with their time and to health plans concerned with how much time their physicians are spending with patients. The key is to not necessarily spend more time in consultation but to make the time spent more efficient.

Do Doctors Really Want More Communication?
Many patients believe that problems in communicating with one’s doctor are because of the doctor’s attitude, and that often doctors do not welcome questions. In reviewing the medical literature on this topic, we found evidence that responsibility actually rests on both sides of the clinical encounter. Practitioners should learn ways to listen and present information that is clear, open, and efficient.3-6 Patients should learn ways to build their knowledge base, prepare themselves to ask questions during consultation, and clearly express their needs and concerns to their doctor.1, 7-9 With even a modest amount of effort to prepare for their medical consultations, patients can help their doctors better understand their needs.1Researchers have found that doctors often make assumptions or inaccurate guesses about patients’ concerns, or may ignore them completely when they’re not clearly conveyed.5 If your doctor is misunderstanding you or not meeting your needs, it is your responsibility to let them know.

Do Doctors Really Want Feedback from their Patients?
Doctors are people too and seek satisfaction in their work; they can readily observe that improved communication leads to better treatment outcomes.5 “Physicians tend to be more accepting of, and responsive to, feedback about communication from their patients than from peers or educators.”5 Direct feedback from the patient, positively framed, can go a long way to helping a doctor be a better practitioner of medicine.

What Kind of Further Research is Needed?
There is still more work to be done on the topic of doctor-patient communication. Important questions remain on how to individualize efforts aimed at increasing patient participation, including the sort of educational approaches that will best help patients to be more active participants in their care. The studies we reviewed for this article do suggest, however, that patients should feel empowered to change the way clinical medicine is practiced and that improving patient-doctor communications is a worthwhile endeavor.

REFERENCES:
1. Harrington J, Noble LM, Newman SP. Improving patients’ communication with doctors: a systematic review of intervention studies. Patient Educ Couns. Jan 2004;52(1):7-16.
2. Williams MV, Davis T, Parker RM, Weiss BD. The role of health literacy in patient-physician communication. Fam Med. May 2002;34(5):383-389.
3. Roter DL, Hall JA, Kern DE, Barker LR, Cole KA, Roca RP. Improving physicians’ interviewing skills and reducing patients’ emotional distress. A randomized clinical trial. Arch Intern Med. Sep 25 1995;155(17):1877-1884.
4. Clark NM, Gong M, Schork MA, et al. Impact of education for physicians on patient outcomes. Pediatrics. May 1998;101(5):831-836.
5. Towle A, Godolphin W. Framework for teaching and learning informed shared decision making. Bmj. Sep 18 1999;319(7212):766-771.
6. Godolphin W. The role of risk communication in shared decision making. Bmj. Sep 27 2003;327(7417):692-693.
7. Street RL. Active patients as powerful communicators: the communicative foundation of participation in care. In: Robinson WP, ed. The new handbook of language and social psychology. Vol 1. Chichester, UK: Wiley; 2001:541-560.
8. Rost K, Carter W, Inui T. Introduction of information during the initial medical visit: consequences for patient follow-through with physician recommendations for medication. Soc Sci Med. 1989;28(4):315-321.
9. Lewis CC, Pantell RH, Sharp L. Increasing patient knowledge, satisfaction, and involvement: randomized trial of a communication intervention. Pediatrics. Aug 1991;88(2):351-358.

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The Responsibilities of the Patient

» Define for yourself the kind of doctor-patient relationship you would like to have.
» Take the time to properly prepare yourself to have a better interaction with your doctor by 1) accessing information on your health condition and treatment options prior to a consultation and by 2) making a written list of questions to ask.
» Make clear to your doctor the kind of information and level of detail you would like. Do you want just the headlines or the fine print? Evaluate this information for yourself. See Avenues 4 for guidelines on how to evaluate clinical studies.
» Obtain copies of, read, and understand as much as you can about your medical records.
» Bring a friend or family member with you to your consultation.
» At the appropriate time in the medical consultation, communicate with your physician this information clearly. Make sure your questions and concerns are fully addressed and that what your doctor is saying makes sense to you.
» Articulate your health problems, feelings, beliefs, and expectations in an objective and systematic manner.
» Negotiate treatment decisions, give feedback, work to resolve conflicts, and agree on an action plan.

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The Responsibilities of the Doctor

» Develop a partnership with the patient.
» Establish or review the patient’s preferences for information, such as amount and format. Do they want just your recommendations, just the summaries of studies in plain language, or full text medical papers?
» Establish or review the patient’s preferences for the role they would like to have in decision-making.
» Discover and respond to patient’s ideas, concerns, and expectations.
» Identify treatment choices and evaluate or interpret those choices in the context of the individual patient. Help the patient reflect upon and assess the impact of different treatment decisions on his or her values, lifestyle, and work or family circumstances.
» Make or negotiate a decision in partnership with the patient and work to resolve conflicts.
» Agree on an action plan for treatment and make arrangements for proper follow-up.

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Questions Doctors Should Ask and Information Patients Should Give

» What kind of person is this?
» What has happened to this person?
» How are they responding to their situation?
» What are their needs at this particular time?

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Questions to Ask in a Medical Consultation

» Could you please explain or clarify…
» What is the evidence for effectiveness for this treatment?
» If you were in my position, what information would you consider it important for me to know?
» What information can you provide me that will best help me to make a treatment decision?
» Where should I go to find more information about my particular condition or the treatment strategies you’re proposing?
» What are the options you don’t recommend for me and why are those recommendations not appropriate?