Patients’ often express varying levels of dissatisfaction following appointments with their physicians. One of the most frequent complaints centers on a lack of clear, empathic communication whereby the patient and physician exchange information that not only serves to reinforce their interpersonal relationship and trust, but also facilitates collaborative decision-making.
Before this problem can be addressed, physicians must first be aware of the deficit. According to an article in the Ochsner Journal, “Tongue et al reported that 75% of the orthopedic surgeons surveyed believed that they communicated satisfactorily with their patients, but on 21% of patients reported satisfactory communications with their doctors.”[i] Similarly, “A study released by the nonprofit Cancer Support Community found that more than half of patients with cancer feel unprepared to discuss treatment options with their medical team…”[ii] In fact, we know from research that “…Only 36 percent of patients facing important medical decisions indicated that they were extremely well informed about the decision confronting them.”[iii]
Yet, rather than assign culpability to the doctor for this informational deficit, the patient often excuses it by saying such things as I know my doctor is very busy and doesn’t have time to answer all of my questions or I didn’t remember an important question until after I left the examining room. While other patients are simply too intimidated to speak up out of fear of repercussions.
Poor communication clearly comes at a high price to the patient: “…Unsatisfactory communication by healthcare providers (including too little information, too much information, and/or abrupt or blunt sharing of information) is named the second highest reason for suffering by cancer patients.”[iv] Physicians, too, pay a price when they fail to satisfy their patients: “Satisfied patients are less likely to lodge formal complaints or initiate malpractice complaints [and] are advantageous for doctors in terms of greater job satisfaction, less work-related stress, and reduced burnout.”[v]
A failure to receive informed consent may carry the greatest cost – both in terms of patient angst and the possibility of litigation! Informed consent, by definition, means the patient must understand all of the standard treatment options for their disease, as well as how these options differ in their potential efficacy, side-effects (short-term and long-term), costs, and other factors. Only then is the patient in a position to assess relative risk versus relative reward.
There are steps patients can proactively take to transform encounters with their physicians from ones of frustration into opportunities for learning and collaboration. Before your first or next appointment, consider the following:
1. Consider having a family caregiver on-board who will attend the appointment and act as your scribe and advocate – ensuring that the information exchanged during that encounter is faithfully recorded, and your needs respected and addressed.
2. Identify trustworthy sources of information that will help you understand more about your disease so that your time with your doctor is not spent on the basics, but on very pertinent questions about your disease and treatment options. For cancer patients, such sources include: Major NCI Cancer Centers, NCCN.org, and the American Cancer Society to name but a few.
3. With your caregiver’s assistance, spend an hour developing a list of questions in advance of your appointment. Consider how the answers to these questions might impact your decisions about treatment. Be clear about what you want to know, as well as what you do not want to hear from your physician. Since there may not be time to answer them all, list them in priority order.
4. Think about how your personal values will come into play when considering treatment options. Write them down, and be in a position to share them with your physician. Personal values vary dramatically, e.g., some cancer patients want to have every possible treatment exhausted before ceasing active treatment, whereas others may put a higher priority on quality of life during the last stages of their cancer.
5. If your doctor’s office is agreeable, consider providing your questions to your physician’s nurse a few days in advance of the appointment with a note indicating that these are topics you hope to have covered by your doctor.
6. When your physician provides answers to your question, ask for clarification if necessary – particularly if there is medical jargon that you do not understand.
7. When agreeing to a treatment, reiterate your understanding of all issues related to the treatment before consenting to it.
Physicians can also take meaningful steps to optimize the learning and collaboration that occurs during patient appointments, by considering:
1. How you provide information is as important as the informational content.
2. The warmth and empathy with which you welcome your patients into the therapeutic relationship will be a tremendous determinant of their comfort and satisfaction with each encounter.
3. Patients may not want certain types of specific information, such as the statistical probability of survival after five years, but virtually every patient wants you to be honest and forthright in answering their questions.
4. Because you have obvious constraints on your time, there may be tremendous value in having your nurse, nurse educator or social worker available for further consultation with the patient.
5. A patient’s decision regarding treatment (or refusal of treatment) may be incongruent with your personal values and thus frustrating. What is important, however, is your agreement that the patient made it from an informed perspective after weighing the pros and cons, and considering their personal values.
6. You will be the beneficiary of excellent communication, and may wish to seek out resources to further hone your skills in this regard.
The operative word for both patient and physician is collaboration. From that collaboration, trusting and valued relationships can be built that enrich the lives of patients and providers.
[i] The Ochsner Journal2010 Sring 10(1):38-43
[ii] Cure Today. http://www.curetoday.com/advocacy/cancersupportc/elevating-the-patient-voice-study-finds-patients-not-prepared-to-discuss-treatment-options
[iii] – Veroff et al. Health Affairs. February 2013..
[iv] – Bevan & Pecchioni, Patient Education and Counseling, 71
[v] Oschner Journal. Pg.