Closing the communication gap between patients and physicians

I lived in Japan in 1991. When I was having a conversation with someone, they would always nod their head as if they completely understood the message I was trying to convey.

It turns out that was not the case. The nodding was a sign of respect. When I began to inquire if they understood what I was trying to say — it became clear that the answer was usually no.

Many physicians are surprised by the findings of a group of Yale researchers who were recently published in the Archives of Internal Medicine.

They found a huge disconnect and a huge communication gap existed between patients and physicians.

  • more than 80% of patients did not know the physician taking care of them
  • nearly 50% of patients did not know their admission diagnosis

On the flip side:

  • the majority of doctors thought the patients knew their name
  • the vast majority of doctors thought the patients had understood their diagnosis

And these results were controlled for many of the variables you would assume would lead to an increase in the communication gap.

Many years ago, I usually concluded each office visit with a question. Did you understand what we discussed?  Did you understand your diagnosis and treatment plan?

I was surprised at how often the answer was “a little,” “most of it,” or just plain “no.” I was spending a lot of time interacting and discussing the aforementioned issues with my patients, and many were nodding their heads as if they understood what I was saying.

So I worked on improving my approach, communication skills, and started using visual tools and simple diagrams and gradually the answer to the questions posed changed to “yes.”

I believe that a physician should seek to elicit from the patient an acknowledgement that they understand their diagnosis, treatment plan, and options.

A simple inquiry can go a long way to minimize the physician-patient communication gap.

Howard Luks is an orthopedic surgeon who blogs at his self-titled site, Howard J. Luks, MD.

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