Can a Simple Inquiry Close the Patient-Physician Communication Gap
I lived in Japan in 1991… why is this important 
— well;
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.
- They found that >80% of patients did not know the physician taking care of them.
- They found that nearly 50% of patients did not know their admission diagnosis.
On the flip side:
- They found that the majority of doctors thought the patients knew their name.
- They also found that 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.
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Many years ago, I usually concluded each office visit with a question…
Did you understand what we discussed? Did you understand your diagnosis, treatment plan, etc?
I was surprised at how often the answer was “a little”, “most of it”, or just plain “no”. Hmmmm…. 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, options, etc, etc, etc….
A simple inquiry can go a long way to minimize the physician-patient communication gap.
I think an excellent question to ask is “When you tell your family and friends about this visit, what will you tell them?” This could be a doctor’s visit, a hospital stay, a physical therapy session, etc.Great post!Mary Pat
Your comments bring up a very important point: There are cultural differences that we physicians encounter every day. In consult, during the span of a single day, I may see one or several of these (very generalized) stereotypes:1) The engaged patient.2) The type A personality (sometimes a subset of #1)3) The “you’re the doctor, I trust you, do what you think is right” patient.4) The foreign-speaking patient requiring a translator.5) Japanese: (as hjluks noted) nod as a sign of respect, which we Americans assume implies understanding6) Indian: son, with parents and a comment to “don’t tell too much” to the elders8) Hispanics: full family, including grandchildren and a trusting, “doctor knows” attitude9) And many moreThe above are generalizations and are in no way meant to get myself in trouble with any particular group of people. They are just observations about how SOME people MAY act when they visit their doctor. Of course, I have seen all of those types of people act differently also.The important thing to remember is that all of those wonderful “groups” of patients deserve, and I attempt to give, the same attempts at full disclosure, i.e. effective communication. It is difficult to imagine, therefore, that a stressed-for-time primary care physician can slow down enough to be able to communicate everything that needs to be said in the short time allotted. That’s where I come in. As a specialist, I have the luxury of having a bit more time to spend with each patient. So when a person says that their doctor didn’t communicate the findings or plan with them, I give that physician the benefit of the doubt, saying so to the patient, and then explain to the best of my abilities what they need to know.As a specialist (interventional radiologist) I can’t tell you how often it is that I see patients in consult who tell me that their doctor “didn’t tell them anything.” I’ve come to realize through discussion with many of those referring doctors, that they of course did communicate some/all relevant information. There is obviously a disconnect between what a patient hears, what a doctor says, what a doctor hears, and what a patient says.Another part of the problem may be that many doctors no longer know how to communicate using “normal English.” I remember being criticized by my OB attending (first rotation in med school) for not using medical terms enough when talking with my patients. —- I took that as a compliment!I think the key from the doctor’s standpoint, is to pay extremely close attention to what we say, how we say it, who we say it to and how the patient responds. Then we can be better assured that we have had a fruitful communication.I’ve added these comments to my web site and expanded a bit further on them.
This is an important post! Thank you for sharing Dr. Luks! I liked your use of visual tools- as I wrote in my post ( http://bit.ly/6VElq9 )- use of new visual technologies is only going to grow.I also liked Paul Dorio’s comment: “I think the key from the doctor’s standpoint, is to pay extremely close attention to what we say, how we say it, who we say it to and how the patient responds” amplifying the importance of listening.Angela DunnODOM LEWIS