The doctor-patient dialogue: As productive as it's ever been or broken?
Photo credit: Petteri Sulonen/Creative Commons
The Doctor–Patient Dialogue Is Productive
Depending on whom you ask, the doctor–patient dialogue is either as productive as it's ever been or broken beyond easy repair.
From rising costs and time constraints to omnipresent and potentially conversation-disrupting electronic health records and smartphones, more barriers separate doctors and patients than ever before. But no matter what drives the two parties apart — or how technology threatens to supplant their conversations — face-to-face dialogue between doctors and patients remains a cornerstone of the practice of medicine. And despite all the potential limiting factors, that dialogue remains both productive and essential.
Don't buy it? Think back a decade or three, when patients weren't so much a part of the decision-making process — as, by all rational accounts, they are today — as they were passive recipients of the advice and information conveyed by the all-knowing physician. Indeed, doctors and patients believe that the added complexity of the healthcare system and the readier availability of information have served to elevate their conversations.
“There are many obstacles in the way of the doctor– patient relationship, but for the most part it is still a sacred, trusted bond,” says Dr. Linda Girgis, a family practitioner who has been in private practice since 2001. “We just have to work at keeping it that way. We are moving from a paternalistic ‘doctor knows best' model to one where doctors and patients are a team.”
Along those lines, patients believe the weight of their input has grown. “Doctors are having a more in-depth dialogue with patients,” says Jackie Zimmerman, a patient who has ulcerative colitis and multiple sclerosis and the founder and executive director of advocacy group Girls With Guts. “Now there's more information, and doctors are more likely to speak to patients as a person.”
MarlaJan Wexler, a nurse who also has lupus and an advocate who blogs at LuckFupus.com, agrees that the doctor–patient dialogue has become more of a two-way street, especially when compared to a decade ago. “In the past, you pretty much went to your doctors and they said, ‘Take this pill and this test.' Now we want to know why we are taking this pill and what this test is going to show — and if it shows something, where we go from there,” she explains. “It's a whole new experience, because [doctors] are actually listening to what we have to say, rather than just looking at the results of our tests.”
That communication has improved, in large part, since patients began arming themselves with information in advance of doctor visits. “I'm a more-educated patient. I take it upon myself to know what I want to ask when I walk into an appointment and I think doctors respect that we have a more efficient conversation,” Zimmerman says.
Wexler agrees, adding that “patients are more in tune with their own health and how medications and foods affect them.”
This has not escaped their doctors' notice, according to Dr. Gwendolyn Reyes, a pediatrician at the Hurley Medical Center in Flint, Michigan. “Everything gets discussed in a little more detail. There are a lot more people using Google,” she explains. “There are definitely deeper conversations on side effects and benefits.”
We've reached a point where some doctors expect patients to perform background research before appointments. A SERMO poll of its online physician community found that 22% of U.S. millennial doctors (defined as doctors born after 1982) expect patients to conduct some degree of research before they step into the doctor's office.
Photo credit: Tadson Bussey/Creative Commons
The Doctor–Patient Dialogue Is Broken
Without a doubt, the increasing availability of health and medical information has helped usher in the era of the “empowered patient.” But according to practitioners and patients alike, it hasn't raised the bar for their conversations.
Despite arming themselves with reams of information, many patients aren't getting what they want — or need — from their doctor visits. The likely culprits? Time constraints, distracting technology, and misplaced anger about healthcare costs.
A recent study funded by Novartis found that while both sides agree on the importance of the doctor–patient dialogue, that agreement doesn't always translate into productive conversations. The researchers polled women with metastatic breast cancer and found that while 89% of patients and 76% of oncologists surveyed believe it is important to discuss long-term treatment plans, 43% of patients reported they never had this discussion.
The reason for that may be as simple as a lack of time, according to Wexler. “There's such a crunch. You wait four or five hours for a doctor and then when you get in, you have 10 to 12 minutes. That's not enough time,” she says.
The time crunch means that patients must come prepared for their appointments — which can be a double-edged sword.
“Patients who go out of their way to educate themselves are having more productive conversations,” Zimmerman reports. “But some doctors expect all patients to be heavy-Googling people and not all of them are. And those patients may be getting a lower-level quality of conversation because doctors assume they already know what they're talking about.”
Wexler notes the potential danger in relying on health information found on the web. “We talk about ‘Google University' and how easy it is to research things, but that information is not always reputable,” she explains. “My parents didn't grow up with Google, so they might not be as willing or able to do the research or the work that it takes to learn about a disease.”
The furor over cost of care has also bled into the doctor's office, according to Dr. Girgis.
“Patients are getting angry about insurance issues, about having to pay more money and receive fewer services from insurance companies,” she says. “A lot of times it's the doctor who tells them this news — ‘your test is not covered.' The anger gets directed toward the doctor.”
The all-EHRs-all-the-time mandate can similarly impede productive conversations between doctor and patient. “I understand [physicians] have to take notes, but I've had full conversations with doctors where they were taking notes the whole time,” Zimmerman says.
At the same time, Wexler believes that a doctor's age can play a part in how attentive he or she is while managing EHRs during consultations. “Sometimes physicians, especially ones from older generations who are used to paper charts, get hyper-focused on documenting things. Their heads are in their keyboards. You wonder how much information they're actually absorbing,” she laments.
Dr. Reyes points out, however, that EHR preoccupation is a problem that spans generations. “Body language is a tool of communication,” she says. “Doctors can get so focused on using the computer that they aren't necessarily sitting down with patients. That can make [those doctors] come across as less empathetic.”