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Washington Advocates for Patient Safety

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Updated on January 28th, 2015 at 9:43 am

Can you guess the biggest complaint consumers have about their healthcare providers?

No, it is not about the long waiting hours. Neither is it about rushed office visits. 

According to a 2013 Consumer Reports’ survey of 1,000 patients, unclear explanations of medical problems by physicians was the number one thing that bothered people the most, with an averaged rating of 8.1, on a scale of 1 to 10.  

In another words, the number one thing that bothers patients is that their doctors do not inform them adequately about their medical conditions and treatment recommendations.

Certainly, it takes time to explain healthcare information. That can be tough when doctors’ schedules are packed nowadays. But, busy schedules aside, there is something else that is missing, i.e., the art of communication.

No one is born a natural communicator. Being a scientist myself, I remember my training and practice on trying to use just a couple of sentences to describe my research or to compact my results into a five-minute talk. It is not easy and takes practice.  I read a recent Nature blog: how to communicate your science in the best way. Steven Palmer, head of press and science communication at Cancer Research UK, ran a “media training booth” at a recent Naturejobs Career Expo in London. He suggested that all scientists should try to explain their research to their friends. “Do they understand roughly what you do? And I don’t mean in a rambling long conversation across a whole Friday night. I mean in 5 minutes. Do they get it? And let them replay it to you. If they’ve got it, you’re fine.”

I found Palmer’s comments interesting because his suggestion could apply to all fields that require effective communication. I can understand that communicating complex health care information can be difficult and sometimes emotional. But, I would like to venture that discussing with a patient about health care should not be any more complicated than a scientific topic.  In any case, healthcare providers should acquire and practice the skills to communicate effectively with patients in a short time window.  

However, for some communication skills are not the only barrier. There are other cognitive biases that may prevent good communications with patients. Just a few days ago, a seasoned physician told me that patients do not understand what doctors have to say, thus causing difficulties in patient-provider communication.

I would have to disagree with this attitude that faults patients for inadequate communications. Between providers and patients, it is the former who have the training and possess the knowledge and information that most patients do not have. Therefore, patients rely on their doctors to inform them what is wrong with their bodies, what can be done about it, and what are the risks and benefits for the recommended treatment or if it is best to do nothing at all.  So I would say it is primarily the physician’s responsibility to communicate clearly and effectively with patients to make sure that they understand the results of examinations and differential diagnosis as well as the recommended treatment plans.

Of course, I understand that the healthcare literacy of the general public needs to be improved. Even with my science background and my professionally trained curiosity, at times I do not understand everything that a doctor tells me. I have learned over the years to be proactive and informed and ask questions.  But, sometimes, even when I asked, I was not given all the information that I needed to make an informed medical decision or my concerns were not listened to and ignored; in a couple of critical occasions, I was deemed as lacking the “medical training” and thus “not capable of making healthcare decisions.”

However, as patients and family members, we do possess unique, critical knowledge that providers do not have:

  • We experience the symptoms with our bodies first hand;
  • We know what is important in our and our loved ones’ lives;
  • We have traveled through our own medical history and know all of it;
  • And, we can and do learn medical knowledge relevant to our health from many resources.

As such, patients and family members may have important information to offer during their medical care consultations. Thus, a good listening skill is essential for being a medical professional and can enhance the communication between a provider and a patient.

A number of other approaches may also help improve provider-patient communications, for example, using the language that patients can understand and applying the teach-back technique. Informative handouts on common illnesses can be helpful as well written summaries after each visit. A better informed patient is a win-win situation for all involved the care.

But, the most important of all is to treat patients and their family members as partners with respect and empathy; listen to what they can offer; address their concerns; talk to them with genuine interest in their welfare; and never loose the human connection. It is this patient-centered focus that makes healthcare communication truly unique, challenging, and often rewarding.

Like everything else, all skills take practice. Communication is no exception. So let’s all work together, physicians and patients, to improve healthcare communication. It is the core of the patient-centered care culture and medical care safety.

Updated on October 30th, 2013 at 3:00 pm

By Yanling Yu and Rex Johnson, Washington Advocates for Patient Safety

On September 30th, 2013, the Safe Patient Project of Consumers Union and Washington Advocates for Patient Safety (WAPS) hosted a joint meeting at the Seattle Public Library to share ideas on how to become smart consumers and protect themselves and family members from medical harm, hospital infections as well as failed hip and knee implants.  It was a well attended event with many presentations and lively discussions.

Lisa McGiffert, Suzanne Henry, and Daniela Nunez from Consumers Union first presented their new campaign to get the top six hip and knee implant makers to provide 20-year warranties on their products. When implants are defective, patients or their insurance including Medicare and Medicaid normally end up paying for additional surgery to replace failed devices. Such a revision can be more costly than original surgery and result in longer hospital stays and complications.  Patients who receive hip implants should be guaranteed a new hip at no cost if their current one fails or is recalled. In addition, the pain and suffering has emotional and financial costs for patients and their family members.

Thus, it seems to be common sense that patients with implants deserve a form of warranty. Such a warranty would have helped Mary Schrag (WAPS), who shared a video that documented a recalled metal-on-metal hip that left a devastating impact on her life. These Metal-on-Metal (M-O-M) hip replacements have an unusually high failure rate, based on data from Australia, England, and Wales where devices are tracked through national registries. Mary’s example clearly shows why manufacturers should live up to their claims and provide warranties on their products. 

Following a lively discussion, members of WAPS presented their work to improve transparency and accountability in medical care to save more lives and avoid preventable harm. Like many patient safety advocates around the country, a number of WAPS members have been personally impacted by medical harm which led to our advocacy for patient safety. By sharing painful personal stories about the harms to our loved ones and our families, we emphasized the importance of patient-centered care, shared-decision making, quality of care, transparency, and accountability. As the third leading cause of death in our country, preventable medical harm is currently killing an estimated 440,000 people in the US each year, as shown by a recent study published in Journal of Patient Safety. Our stories highlighted the human toll of medical harm and reminded everyone that behind the statistics of each medical harm, there was a beautiful, precious human life and their family. You can access these presentations here.

To save more lives and to be a voice for patients, we have been collaborating with Consumers Union’s Safe Patient Project for several years. More recently, we worked together to protect the WA hospital infection reporting law that retains reporting of infections involved hip and knee replacements and cardiac surgeries. With more people undergoing hip and knee replacements, patients need to be able to see their local hospitals’ infection rates for these procedures, which can help people make informed medical decisions.

At the meeting, Dr. Robert Mecklenburg at Virginia Mason also gave an introduction on the Robert Bree Collaborative, a statewide public/private consortium established in 2011 by the Washington State Legislature “to provide a mechanism through which public and private health care stakeholders can work together to improve quality, health outcomes, and cost effectiveness of care in Washington State.”. The Collaborative is in the process of creating a warranty for the surgery itself involved with hip and knee replacements. By bundling packages of care, they can offer a warranty for specific procedures that go wrong and provide additional care at no cost.

Another informative talk was given by David Ansley with Consumer Reports. He presented on the Consumer Report’s Choosing Wisely campaign and how it’s helping to change the culture of excessive medical care.   Through this campaign, Consumer Reports is working with doctors to help patients avoid unnecessary and potentially harmful medical care.  Doctors often order tests and recommend treatments when they are not needed—sometimes even when they know they shouldn’t. In fact, nearly half of primary-care physicians say their own patients get too much medical care, according to a survey conducted by researchers at Dartmouth College. And the Congressional Budget Office says that up to 30 percent of the health care in the U.S. is unnecessary.  David Ansley pointed out that patient need to ask if every treatment is necessary and to say “No” to unnecessary ones.

All in all, to choice wisely and eliminate preventable medical harm, we must engage patients and their families in patient-centered care and shared decision making process.  Partnering with patients through out the journey of care is absolutely essential to quality of care.

 The opinions in this blog reflect that of the authors and not the University of Washington.

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