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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  • Finn

    Asking yes-or-no questions is not the best way to determine whether your patients understand what you’ve told them. Many–especially older and immigrant patients–are likely to say “yes” out of politeness. The best way to determine whether they understand their diagnosis is to ask them to tell you in their own words what’s wrong with them, how you’re going to treat it, and what their role in the treatment plan is. What they tell you won’t be as detailed as what you told them, but it will let you know quickly if they’ve misunderstood what you’ve said.

    • Debra

      Just ask me if I understand and if I have any questions. If I tell the doctor that I get it when I don’t, it’s my fault as the patient for not speaking up.

    • WarmSocks

      Finn, that was my thought, too. Yes/no would be faster, but not as informative.

  • Ann Becker-Schutte

    I think that what Finn was expressing was an awareness that many patients (because of age, socialization, intimidation, etc) may not feel empowered to ask questions. Using open ended check-ins can help doctors facilitate more empowerment and get a more thorough assessment of patient understanding.

  • Lillian Arleque, Ed.D.

    As an educator, I will tell you that the speaker is always responsible for clarifying with the receiver whether the communication has been understood….it is called “check for understanding.” Every physician should work with an experienced educator, not necessarily a medical professional, to learn how to best educate their patients. As educated and skilled physicians may be, if they do not learn how to explain, using all modalities, a diagnosis and reasons for treatment plans then they are not providing the level of excellence and care that patients deserve.

  • Eric Goodnight

    Great post. This is an important issue, and one that more IT vendors could be trying to tackle. Depending on the situation, the issue may go beyond simply understanding the language. There are cultural implications as well, were was alluded to in the opening of the post. Companies like mine have developed tools to accommodate both patients and providers in such settings.

    • MM

      What kinds of tools Eric?

  • Marni Myers

    In linguistics, we call the behavior you describe from your Japanese patients “back-channeling,” which is what we do to indicate we are listening to another person. In the US, this generally takes the form of “uh-huh,” “yeah,” and head nods. Several linguistic studies have concluded that American men often take such signals as being signs of agreement whereas the women who are listening to them intend only to convey that they are listening, potentially leading to some big misunderstandings.

    I appreciate the steps you describe to encourage and determine understanding in your patients. Such steps not only ensure you’re explaining things in an accessible manner, they also likely make patients feel more comfortable speaking up and telling you when they don’t understand. In situations where patients still feel too timid to indicate they don’t understand, there’s now a way for them to record their doctor’s visit on their cell phone and upload it to a website where they can listen to it again and again, hopefully gaining the understanding that they missed in the doctor’s office. Patients can do this via the website The site has other tools to help patients bridge this communication gap as well.

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