Effective Patienthood Begins With Good Communication

Given all the obstacles that prevent us from getting to the doctor’s office it is good health sense to make the most of your time when you are finally face-to-face with your health care provider.

Easier said than done, says health researcher Sherrie Kaplan.

“We’re in various states of undress, we are nervous, naked and we didn’t prepare. What a setup for a performance fiasco,” says Kaplan, associate dean for Clinical Policy and Health Services at the University of California Irvine School of Medicine.

Kaplan says the lifetime probability of being a patient in the United States is 100 percent, so each of us should practice for “effective patienthood.”

Kaplan studies interactions between patients and physicians. According to her research there is a teachable window for patients just before they are called into a medical appointment. “In the 20 minutes when patients would normally be reading a magazine, our researchers showed them their medical records and guided them through a diagram of how their disease is going to be managed, then we sharpened up their questions,” Kaplan says.

“We call it ‘coached care.’ We try to tell patients: Go in prepared, think of those three things you want to get out of the encounter. But also be flexible, understand what’s going on, be there in the moment and ask questions,” she says.

Audio recordings revealed that coached patients and doctors communicated more effectively. Kaplan’s team also found improvements in some health markers, like blood glucose and blood pressure.

Most patients do not have access to Kaplan’s coaches or any kind of patienthood training, yet the current medical system almost demands that patients be ready to make good use of limited time with the doctor.

Negotiating a medical visit takes skills that are neither easy nor innate for most people, but research on doctor-patient interaction suggests learning those skills is worth some independent effort. Consider the alternative. Unprepared patients may waste time and money or miss vital health information.

Many health organizations have developed checklists or other tools to aid patients during a doctor’s visit, but internal medicine physician Francesca Dwamena says effective patienthood usually requires more.

“Patients who’ve been ‘activated’ with a checklist or other tools are actually less satisfied with their medical encounter, perhaps because they know how things should go but they don’t have the skills to achieve that goal,” says Dwamena, an associate professor in the Michigan State University Department of Medicine.

Dwamena and colleagues developed a three-session course to coach Medicaid participants on ways to better communicate with their doctors. The course includes role-playing as well as information on the structure of a typical medical encounter, and participants are shown videos of different models of doctor-patient interaction.

The Medicaid patients also learned how to tell their stories. “The physician needs to get the whole picture,” Dwamena says. “The first is the physical part, which is the symptom that they came with,” she says. “There is also the personal, social context of the physical problem. Patients need to ask themselves, ‘Are the circumstances of my life affecting the symptoms of this disease?’”

Emotions are important too, Dwamena says.

Susan Beach, from Lansing, participated in the Michigan State course. The 40 year-old fast food cashier has knee pain, high blood pressure and chronic stomach trouble.

“If I’m feeling depressed, that might help my doctor. Telling him what I’m going through, what’s going on in my life stress-wise, that could help him pinpoint maybe what’s going on with me. I never knew that,” Beach says.

Dwamena explains how speaking up paid off for one student. “Her doctor said he had 10 minutes, but it turned out they spent about 30 minutes and he answered all of her questions,” says Dwamena. “The doctor was more open because she was.”

Still Dwamena admits some patients can go overboard. “If you have 15 minutes and the patient expects to cover 20 complaints, it’s pretty frustrating,” she says. But she adds, “I am happy when a patient comes in and has read some information about their illness and has some questions. You feel stimulated, you are on your guard and you are more careful.”

Communication researcher Richard L. Street, Jr., says when a patient and physician meet there are two experts in the room.

“Take the case of a clinical breast exam. The doctor has probably done countless exams and knows what’s abnormal. But the woman, if she has been doing self breast exams, also knows what’s normal,” Street says.

Physicians and patients should strive for agreement at the end of a medical encounter, an agreement that considers the patient’s values and everyday realities, says Street, director of the Program in Health Communication and Decision Making at the Baylor College of Medicine.

“Medical care is a conversation. So to have influence in that conversation you have to speak up,” he says.

“You get very little adherence to doctors’ recommendations when you didn’t get the patient buy-in on what will work for them,” Street says.

Extracted from The Prepared Patient, Volume 1, Issue 3, September 2007, provided by the Center for the Advancement of Health in Washington, D.C.

Make The Most Of Your Next Doctor’s Visit

Before you go . . .

• When making the appointment, state the nature of your concern so that a proper length of time can be scheduled.
• Be ready to provide information about diseases that run in your family and describe current and past health problems and treatments. Write it all down if that helps.
• Make a list of medications you are taking, including the doses and frequency of prescription and over-the-counter drugs, as well as herbs, supplements and vitamins.

While you are there . . .

• Your health is worth the physician’s time. Restate explanations and ask for clarification.
• Don’t forget about your emotional health.
• Try to reach an agreement about the treatment plan.

Before leaving . . .

• Find out if and when you should return for another visit.
• Ask if you need to watch for certain warning signs for your condition, ask when you should be concerned and at what point you need to call in.
• Get backdoor contact information. What’s the best way to reach the doctor if you have questions or concerns?
• Never leave being uncertain about your diagnosis or treatment plan.

Source: Adapted from the Allina Hospitals & Clinics Web site: www.allina.com