The doctor-patient dialogue: As productive as it's ever been or broken?

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.

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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.”

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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.”

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