"Doctor and Patient, Now at Odds"--New York Times blog

Doctor and Patient, Now at Odds

By TARA PARKER-POPE
Published: July 29, 2008
New York Times Health blog: Well

Excerpt:
“By the time you’re done with your training, you feel, in many ways, that you are as far as you could possibly be from the very people you’ve set out to help,” said Dr. Pauline Chen, most recently a liver transplant surgeon at the University of California, Los Angeles, and the author of Final Exam: A Surgeon’s Reflections on Mortality (Knopf, 2007). “We don’t even talk the same language anymore.”

Continued: http://well.blogs.nytimes.com/2008/07/28/doctors-and-patients-a-rocky-relationship/

Patient-physician Communication: Research

With their waiting rooms crowded and exam rooms full, many physicians say they are too busy to be good communicators. Those who study physician time-management think otherwise. Certain communication skills can foster efficiency and effectiveness during an office visit without sacrificing rapport with patients, according to researchers at the University of Washington (UW) and the University of Rochester.

Their guide to a smoother flow of communication between doctors and patients appears in the July 14, 2008 issue of the Archives of Internal Medicine. Their model is based on the authors' observation: "Effective communication in primary care must include skills that enhance the quality of care while helping patients and physicians use time wisely… Making the best use of available time is important for visits of any duration."

A few of the lessons the researchers presented in the resulting article, "Relationship, Communication, and Efficiency in the Medical Encounter: Creating a Clinical Model from a Literature Review" include:

• focus the purpose of the visit with the patient: Instead of addressing each issue as it surfaces, creating a list at the start enables the doctor to confirm which problem is most medically urgent or most important to the patient. This approach also reduces the "Oh, by the way" issues brought up at the end of the visit.
• understand the patient's perspective: Exploring the patient's viewpoint is useful for promoting self-management, suggesting healthy changes, assessing motivation, learning the patient's family and cultural beliefs, understanding the social and psychological problems that are diminishing the patient's ability to function, or getting to the root of medically unexplained symptoms.
• reach a mutual agreement on a plan: The physician and patient decide on approaches the patient is willing to follow to manage or prevent the health concerns explored during the visit.

Throughout the office visit, it's helpful for physicians to:

• establish rapport and maintain the relationship: Some ways doctors do this are by eye contact, recognizing others in the room, or a brief warm greeting, such as, "Nice to see you." On the other hand, too much small talk steals away time from considering the patient's problems.
• practice mindfully: This occurs when physicians pay close attention to their own beliefs and reduce distractions in order to observe their patients' response to what is being said and done, and adjust accordingly. For example, a doctor lecturing on excess weight might notice the patient withdrawing. The doctor stops and asks about the patient's views. A physician who doesn't continuously monitor the interaction or doesn't check in with the patient may cover areas of little interest to the patient, and miss significant issues.
• track topics: Sometimes an interview veers off course, particularly when there are multiple topics and no clear agenda. Unless the conversation is redirected, it's likely that no clear decisions will be made on some problems before the end of the visit. Sharing an impression of what has and hasn't been covered and realigning by agreeing on what to talk about next can keep the discussion organized.
• acknowledge cues: When a physician responds with empathy to a patient's cues, a patient may reveal beliefs and preferences that can shape a successful treatment plan. Also, once their concerns are taken into account, most patients don't keep restating them. This saves time.
  

Researcher Larry Mauksch said, "Visits with the doctor that contain these fundamental elements lead to greater patient satisfaction, better adherence to medical regimes, increased self-management, better health outcomes, lower costs, and fewer malpractice claims. These skills enable physicians to do it right the first time, so they don't have to do it over."

The researchers are Larry Mauksch, a UW behavioral scientist in family medicine who studies and teaches doctor/patient communications; David C. Dugdale, an internal medicine physician and director of the UW Hall Health Primary Care Center; Sherry Dodson, UW clinical medical librarian; and Ronald Epstein, professor of family medicine, psychiatry, and oncology at the University of Rochester School of Medicine and Dentistry and its Center to Improve Communication and Health Care.

To read more about the project: http://uwnews.org/article.asp?articleID=42811

Bringing Companions to Medical Visits: US Study

According to a survey of 12,018 US Medicare beneficiaries 65 years or older, bringing a family member or friend to medical visits improves patient satisfaction with medical care. Researchers found that:

• 38.6 percent of participants reported regularly being accompanied to medical visits
• Companions included spouses (53.3 percent); adult children (31.9 percent); other relatives (6.8 percent); roommates, friends or neighbours (5.2 percent); non-relatives (2.8 percent); or nurses, nurse aides or legal or financial officers (less than 1 percent)
• 63.8 percent of companions helped with communication, including 44.1 percent who recorded physician comments and instructions, 41.5 percent who communicated information about the patient’s medical condition to the physician, 41 percent who asked questions, 29.7 percent who explained physician’s instructions and 3.3 percent who translated the English language
• 28.4 percent of companions were reported to be present for company and moral support, 52.3 percent to assist with transportation, 16.6 percent to help schedule appointments and 8.4 percent to provide physical assistance.

Beneficiaries with regular companions were more highly satisfied with their physician’s technical skills, information-giving and interpersonal skills. Those whose companions more actively helped with communication rated their physicians’ information-giving and interpersonal skills more favourably. This relationship was stronger among patients who reported themselves to be in worse health.

Article:
Jennifer L. Wolff; Debra L. Roter
Hidden in Plain Sight: Medical Visit Companions as a Resource for Vulnerable Older Adults
Arch Intern Med. 2008;168(13):1409-1415.

2008 International Conference on Communication in Healthcare

Time sensitive

2008 International Conference on Communication in Healthcare
2-5 September 2008
Oslo, Norway
Earlybird rate available until July 18th

Program includes:

• Teaching communication skills
• Shared decision making
• Disclosure of medical errors to patients
• Analyzing clinical communication behaviour
• Emotion and nonverbal communication
• Communication in cancer care
• Communication in different clinical settings
• Family issues and communication with children
• Gender issues in communication
• Patient and provider perspectives
• Cultural perspectives
• Web-based interventions and information technology
• Patient education

Plus posters and exhibition area.


http://www.each-conference.com/

PatientsLikeMe.com: Online community of patients, doctors, and organizations

PatientsLikeMe.com was launched in 2004 by "three MIT engineers." It is described as:

a privately funded company dedicated to making a difference in the lives of patients diagnosed with life-changing diseases. Our personal experiences with ALS (Lou Gehrig's disease) inspired us to create a community of patients, doctors, and organizations that inspires, informs, and empowers individuals. We're committed to providing patients with access to the tools, information, and experiences that they need to take control of their disease.

For more, visit: http://www.patientslikeme.com

Patient education video and audio information

The US Agency for Healthcare Research and Quality (AHRQ) provides a wealth of practical patient information. Especially helpful are video and audio files from AHRQ's Healthology website and Healthcare 411 series.

From Healthology:
Tips for Taking Medicines Safely (video; 5 minutes)

Next Steps After a Diagnosis (video; 8 minutes)

From Healthcare 411:
How to Ask Tough Questions of Your Doctor (audio; nearly 4 minutes)

Family Health Advocacy (audio; 10 minutes)

Using stories to facilitate family centred care education

Family Centred Care Learning Vignettes is a new resource produced by the Southern Alberta Family & Community Resource Centre. Available in PDF format, the 178 page document capitalizes on the power of story in communication and learning.

From the Preface:
"The cornerstone of family centred care is real partnerships between children, youth, families, staff, professionals, and health organizations. ... We build on the strengths and knowledge of families and make programs and services better by working together." (p. ii)

Themes include:

* Communication
* Roles
* Collaboration
* Information Sharing
* Support
* Patient Safety
* System Policies and Procedures
An appendix includes the full transcripts of "family, Child and Youth interviews."

Interviews addressed four questions:

1. What do children and families want to tell health care professionals?
2. What worked well in their patient, their child's or their sibling's health care experience?
3. What could have gone better?
4. What are their ideas and suggestions for improvement?

View or download the Family Centred Care Learning Vignettes from the Southern Alberta Child & Youth Health Network website.

Prescription labels geared toward pharmacies, not patients

The labels on most prescription drug containers highlight the pharmacy’s name or logo rather than instructions on how to take the medication, reports a new study in the September 10th issue of the Archives of Internal Medicine.

In the US, the Food and Drug Administration has some standards on what prescription labels must include, but few regulations guide the format of the information, said lead author William Shrank, M.D., of Brigham and Women’s Hospital at Harvard Medical School.

In the study, six pharmacies in four cities filled identically written prescriptions for four commonly prescribed medications. The pharmacies included the two largest chains, two grocery stores and two independent pharmacies.

Researchers evaluated 85 labels. They found the pharmacy name or logo was the most prominent item on 84 percent of the labels, with an average 13.6-point font size. By comparison, the instructions averaged a 9.3-point size and medication names averaged an 8.9-point font. Warning stickers were in a much smaller, 6.5-point font on average.

“Medical education guidelines explicitly suggest that font size must be 12 point or larger to optimize patients’ ability to read health information,” according to the authors.

All of the labels listed the pharmacy name first, and instructions appeared fifth on 89 percent of labels. When color font or boldface was present, it was most often for pharmacy information rather than for instructions or warnings.

The authors suggest that one way to improve readability and patient understanding of labels is for FDA to initiate a national standard for their format and content—much like it did with the “Nutrition Facts” labels required on food packaging.

Jennifer Athay, a staff pharmacist with the American Pharmacists Association, said, "Logistically, there is no way to get all the information someone needs to know on a little prescription bottle or tube. Size tends to be an issue, so the complete information you need to know is dispensed in the extra paperwork you get from the pharmacists.” She added that patients should ideally get detailed information when physicians first prescribe the medication to them.

Reference:
Shrank WH, et al. The variability and quality of medication container labels. Arch Intern Med 167(16), 2007

BC Schizophrenia Society offers translated materials

The British Columbia Schizophrenia Society offers fact sheets about schizophrenia in Bengali, Chinese, Hindi, Punjabi, Spanish, and Urdu. Information in French is available through a link to La Société Québécoise de la Schizophrénie website.

To view these fact sheets and to access other information about schizophrenia, support and activities in BC, vist the the BC Schizophrenia Society website at http://www.bcss.org/.

The Health Literacy Study Circles + Guides

A series of health literacy resources are available at the National Center for the Study of Adult Learning and Literacy (NCSALL).

The series includes: Skills for Disease Prevention and Screening (2007), Skills for Chronic Disease Management (2005), and Skills for Health Care Access and Navigation (2005).

From the website:"The Health Literacy Study Circles + Guides consist of two parts. The first is a separate book titled: Introduction: Overview, Planning, and Facilitation Tips. The second is the Facilitator’s Guide, prepared in notebook format, containing all the information needed for each of the three Health Literacy Study Circles + ."

For more about the series, visit http://www.ncsall.net/index.php?id=769

Bipolar Disorder: A review of Medication & Self-management Strategies

TIME SENSITIVE

Bipolar Disorder: A review of Medication & Self-management Strategies is an education night for consumers and their families

July 10th, 2007
7:00 - 9:00 pm
UBC Robson Square Theatre
800 Robson Street
Vancouver, BC

Pre-registration required (seating limited)
Cost: $5.00 (waived in cases of financial hardship)

Contact:
Heather Armstrong
UBC Mood Disorders Centre
Room 2C7-2255 Wesbrook Mall
Vancouver, BC V6T 2A1
phone 604-822-8045
email hla@interchange.ubc.ca

A flyer with speakers and topics is available.

Drug information too hard to read and understand

To make drug information easier to read, researchers recommend:
• using short, familiar words and short sentences
• using short headings that stand out
• using the largest possible type size
• leaving plenty of white space
• using bullet points to organize lists.

Earlier this year, researchers announced the results of a systematic review of studies examining the usefulness to patients of medication information sheets. The review covered the United Kingdom, Europe, Australia and the United States and found that information does not meet the needs of patients. Poor layout and complex language often hinder communication.

The reviewers emphasize that patients want written information in addition to—not instead of—spoken instructions from their health care professionals. Many people would like information that better helps them evaluate potential benefits and harms of a drug treatment. Lead author D.K. Raynor, Ph.D., of the University of Leeds in England says that one key finding was an apparent dichotomy between prescriber and patient views of the fundamental purpose of drug leaflets.

Some providers see increasing treatment compliance as a primary function. In contrast, patients say an informed decision not to take a medicine is also an acceptable result. “Patients see the role of written medical information as guiding them in terms of which medicine is right for them and, if they take the medicine, how best they can use it,” Raynor said. To that end, patients would also like to see more balance between benefit and harm information.

Current drug information focuses too heavily on warnings and adverse effects of the medication, Raynor said. “Patients also need to know how it might benefit them and how likely it is to benefit them.” Exactly how to convey the likelihood of benefits and harms most clearly remains in question. Verbal descriptors like “rare” or “common” are too vague, according to the review.

Yet, more scientific terminology like percentages or “numbers needed to treat” can also confuse the lay public. More research is needed in how best to communicate probability data to consumers, the reviewers say.

To read the full report:
Raynor DK, et al. A systematic review of quantitative and qualitative research on the role and effectiveness of written information available to patients about individual medicines. Health Technology Assessment 11(5), 2007.