Analyzing the communication between doctor and patient

Interesting article from the NY Times investigating communication between physicians and patients. Here are some excerpts:

. . . Two decades ago, in 1984, researchers showed that on average, patients were interrupted 18 seconds into explaining their problems. Fewer than 2 percent got to finish their explanations.

. . . Research shows that only 15 percent of patients fully understand what their doctors tell them, and that 50 percent leave their doctors’ offices uncertain of what they are supposed to do to take care of themselves. Studies suggest that women are better at building relationships with their doctors than men. The typical number of questions a male patient asks during a 15-minute doctor’s visit is zero, while women average six . . .

I have to say, I sometimes fall into the “interruption trap” myself. I think this is a natural progression to our managed care environment. Physicians are compensated by quantity of patients seen, and are kept to a strict schedule – in most cases every 15-mintues. Physicians who are late, get sued.

. . . Today, however, the rise of managed care has helped make doctor-patient communication a major issue that is drawing increasing interest from researchers. Researchers have linked poor communication to misdiagnoses, the ordering of unnecessary tests, and the failure of patients to follow treatment plans.

The reason for the excessive ordering of tests is because everything a physician does has to hold up in court. Objective findings – like an imaging study or blood test – are much more concrete than subjective findings – like patient history. Much easier to order a test, than to listen for 10 minutes and then ordering the same test anyways.

For a number of reasons, adapting school lessons to real-life medical encounters often fails.

I can think of several reasons – physician trainees are shielded from the lawsuits; shielded from time pressures; shielded from managed care; and, most importantly, shielded from reality.

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