Doctor—Patient Confusion

Many posts here at Diabetes Flashpoints have dealt indirectly with doctor–patient communication, covering topics such as medical priorities and technological advances. There seems often to have been an assumption, however, that doctors and patients understand each other at the most basic level — that is, that doctors accurately heard what their patients said about their health problems and that patients accurately heard and understood their doctors’ advice. Research conducted in recent years, however, indicates that this may not be the case in many situations.

A study published last year in the journal Arthritis and Rheumatism, for example, found that in consultations between 74 people with knees severely affected by arthritis and their doctors, 13 doctor–patient pairs, or 18%, disagreed afterward about whether the doctor had recommended knee-replacement surgery. According to a Reuters article on the study, doctors also tended to think a patient’s arthritis was less severe than the patient did. When evaluating what treatments to recommend, they also gave less weight to potential complications of surgery than patients did — indicating that they may not have asked about the patient’s priorities and concerns.

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A review of decades of studies on doctor–patient communication, published in 2007 in the journal Medical Care, found that effective communication results not only in higher patient satisfaction but in better medical outcomes. According to an article on the review at ScienceDaily, in the 36 studies, better communication was found to result in lower blood glucose levels for people with diabetes, lower blood pressure for people with hypertension, fewer chronic headaches in headache sufferers, and improved emotional health among all patients, among other positive outcomes. One researcher mentioned that despite the obvious importance of good understanding and communication, according to a 1999 study, doctors confirm that a patient understands what they have discussed during an appointment (by asking the patient) only 1.5% of the time.

Recognition of the importance of patients understanding their doctors’ advice has led, understandably, to calls for health-care professionals to employ techniques for better communication — and not just to make their own message to the patient clearer, but also to enhance their understanding of the patient and his particular concerns and needs. One of these techniques is called “motivational interviewing.” As its name suggests, the purpose of motivational interviewing reaches beyond better communication and understanding; it aims to instill patients with a desire to tackle their health problems. This involves asking patients open-ended questions about their health and treatments, then listening actively and expressing empathy. Health-care professionals are encouraged to ask questions such as, “What have you done to work on lowering your blood glucose?” or, “How do you plan to lower your blood glucose in the next three months?” Proponents claim that this approach empowers patients and facilitates a more productive doctor–patient relationship.

What do you think — do you feel communication between you and your doctor is as clear as it could be? Have you ever experienced a major misunderstanding or disagreement? Would you like your health-care team to use more elements of motivational interviewing — or, if it uses some already, do you find this helpful? Leave a comment below!

  • Dr. Gary Wainer

    As a physician, I have to agree wholeheartedly. WE all have stories of patient’s returning to us and saying, “well doctor you told me so and so” only to be incredulous that it was significantly different than my recollections or notes would indicate. During my training we were not trained to communciate with patients. We were taught to gather data and to control the converstaion. We also were never tuaght to consider the issues from the patient’s perspective- but rather the “medically appropriate” thing to do ( which may or may not be the “correct thing to do” for the patient). I think as docs and patients have become more sophisticated, they have begun to engage in 2 way converstaions, not the tradiitonal collection of data nd pronouncements of diagnoses and treatments.