In a report from the Archives of Internal Medicine, it was reported that most hospitalized patients (82%) could not accurately name the physician responsible for their care and almost half of the patients did not even know their diagnosis or why they were admitted. Of the physicians, 67% thought the patients knew their name and 77% of doctors thought the patients “understood their diagnoses at least somewhat well”. Although 98% of physicians thought they discussed their patient’s fears and anxieties with them, only 54% of patients thought they did.
Blogger Dr. Toni Brayer suggested several possible explanations for the communication gap:
- Patients are stressed while hospitalized and do not remember what is said.
- Many patients are heavily medicated and that affects ability to learn and remember.
- The trend to get patients out of the hospital quickly short changes communication time.
- Nurses, consultants and hospitalists don’t communicate well together and the patient gets a different message from each visit.
- Doctors are too rushed and deliver information too quickly to be understood.
- Hospitalized patients have too many consultants and no one is identified as the “responsible physician.”
And I would add:
- Doctors don’t pay enough attention to cultural differences.
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:
- The engaged patient.
- The type A personality (sometimes a subset of #1)
- The “you’re the doctor, I trust you, do what you think is right” patient.
- The foreign-speaking patient requiring a translator.
- Japanese: nod as a sign of respect, which we Americans assume implies understanding
- Indian: son, with parents and a comment to “don’t tell too much” to the elders
- Hispanics: full family, including grandchildren and a trusting, “doctor knows” attitude
The 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, and how the patient responds. Then we can be better assured that we have had a fruitful communication.
Paul Dorio is an interventional radiologist who blogs at his self-titled site, Paul J Dorio, MD.
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