Closing the Communication Gap Between You and Your Doctor
The new year always ushers in a period of anxiety for people who have switched health plans. Changing insurers usually means you will be meeting a new doctor for the first time.
If you find yourself in that boat, take a look at the new book by Los Angeles physician Barbara M. Korsch. She is a pioneer in the study of doctor-patient relationships, having launched her first studies on the issue about 50 years ago. The book, “The Intelligent Patient’s Guide to the Doctor-Patient Relationship” (Oxford), is co-written by Caroline Harding.
A professor at USC and Childrens Hospital, Los Angeles, Korsch wrote the book because she believes patients can get more out of their doctor appointments. But, she cautions, you need to learn to talk so your doctor will listen.
Question: How did you become interested in doctor-patient relationships?
Answer: I was at Cornell-New York Hospital, where you have a very highly motivated population of patients. We had a practice of reviewing patients’ records at the end of the day with special emphasis on whether patients had come back if there was a problem. I began to look at the charts, and I noticed that the patients were not coming back or were not doing what they were told.
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Q: How did you begin your studies?
A: I began to ask other doctors to send me their uncooperative patients. I began to realize that the themes with these patients had nothing to do with their technical care but that something had broken down with communication.
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Q: Were those uncooperative patients angry?
A: Not necessarily. They said they were dissatisfied. When I asked why, they’d say, “The doctor never did understand what was worrying me.” They felt the doctor had really not understood their problem. And if someone gives you an answer when you think they haven’t understood your question, you’re not going to do what they tell you because you think it’s irrelevant.
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Q: What did your early studies reveal?
A: We found two common areas where the breakdowns were either the patient thinking the doctor had not perceived their real concern or they had expectations that were not met. What we find in systematic studies is that the doctor may have understood the concern, but the doctor doesn’t have the skills to let the patient know he has understood the concern. The same goes with the expectations. The doctor doesn’t necessarily do what a patient wants him to do. But the doctor has to say, “Well, I can see where you think [that] should be done.” The doctor has to not only understand but let the patient know he understands.
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Q: Why are doctor-patient relationships important to people’s health?
A: What has really convinced people is the extent to which patient satisfaction correlates with patient compliance. We were the first to demonstrate a high correlation. Some doctors say, “I’m not in the business of satisfying my patients. I want my patients to get well.” In fact, compliance is something all doctors want.”
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Q: Do patients get better faster if they have a good relationship with their doctor?
A: There are now a number of studies that show direct, biologic outcomes are improved in the presence of certain kinds of communication.
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Q: Have doctor-patient relationships improved over the years?
A: I’m the eternal optimist. I’d say yes. I think the main credit for this is from the patients communicating better. They’ve become more health-educated, more aware of their own rights, more articulate, more activist. In fact, that is the only reason my research was funded, because the patient community was beginning to become upset with doctor-patient relationships. The doctors thought they were doing great.
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Q: What one thing do patients do frequently to deter the communication process?
A: They are unclear in what they want from the doctor. Not having a very clear idea of what you’re there for and what you hope for leads to rambling, disorganized, time-consuming speech. . . .
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Q: Doctors hate that, don’t they?
A: They hate that. The patient hasn’t decided what their priorities are and what they are going to say to the doctor. They are unprepared, and they are anxious. It is a relationship that is anxiety-producing. Patients do feel disempowered. Finally, it is very hard for a patient--this is one reason I wrote the book--to realize what information is going to be helpful to the doctor and what is not. Before the visit, patients have to organize their thoughts and think about what they really want to tell the doctor.
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Q: What do doctors typically do wrong in the communication process?
A: They don’t listen. They have an agenda. They know what they are interested in. They don’t listen and often they do themselves out of important information, not just psychological, but important biological facts.
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Q: Are patients today less tolerant of being sick and more demanding of some type of treatment?
A: Yes, we all think there should be some solution, some quick fix.
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Q: How has the move to managed care affected doctor-patient communication?
A: There is much more quality control in the HMOs now. HMOs are getting to be a force for encouraging the education of doctors on patient communication.
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Q: But doesn’t changing doctors hurt communication?
A: Continuity of care is very important. And it’s a real regret on my part that that is so threatened. But for most of our population, they never had a regular doctor. That was never a reality. But it’s still desirable. . . . We have also found a crucial factor in communications is whether the patient has been assigned a doctor. I guess patients feel they already have no options if they are assigned to someone. I think maybe if doctors discussed that fact with the patient they could get past it. The doctor could say, “I’ll do my very best to get to know you.”
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Q: Are doctors frustrated by the lack of good relationships with their patients?
A: Yes. When doctors say “my patient” that has a very positive connotation.
