Closing The Doctor-Patient Gap

Advice on communicating with doctors from one of the FamilyCare America’s experts.

“Give It To Me Straight”

Many caregivers have questions about how to improve communication with their physicians regarding their short- and long-term prognosis and how to get “real world, straight talk” about the implications of that prognosis.

Ken Faulkner, M.A. Clinical Ethics, M.Div, is a faculty member in the Department of Patient Counseling at Virginia Commonwealth University specializing in adult oncology, crisis intervention, and bereavement support. Below, he shares his thoughts on this issue:

“Communication between physicians and patients and their families has been a long-standing problem in the health care environment. Many patients can tell stories of caring, compassionate doctors who took the time to listen to their difficulties and in return gave great detail about treatment options and potential outcomes. Unfortunately, just as many patients and families are able to recount stories in which hardly any dialogue occurred, leaving everyone in the dark about what was happening medically and why. There are numerous reasons for the breakdown in communication. It may be helpful to examine these barriers to good communication before moving on to a discussion of how these barriers can be overcome.

“Sometimes the difficulty with communication rests with the patients and families themselves. And understandably so. Today, when you enter the hospital or clinical setting you realize that you are in a strange, foreign land. The hospital setting can be very intimidating for the average person. It is a high-tech world with a highly trained staff that uses medical jargon and code language few ‘outsiders’ can understand. The combination of being sick and being cared for in this mysterious environment can create much anxiety and fear for patients and families. This anxiety sometimes causes patients to feel even more helpless and less able to articulate clearly what they need and when to ask for assistance. Sometimes patients don't suffer from too little communication but from an overload of information that is hard to understand and sort through. It can be embarrassing to feel so in the dark that you don't even know what to ask. So some patients and families prefer to keep their questions to themselves and suffer in silence.

“However, it is a far greater concern when the physicians and other medical caregivers are the ones who are silent. And this occurs for many reasons. In the modern health care institution, it is action that is rewarded and not communication. The average physician today maintains a hectic pace in order to keep his or her practice alive and thriving. There are numerous demands upon the time of the average doctor, not the least of which is coping with the managed care insurance system. Sometimes physicians spend more time on the phone arguing with the insurance companies for treatment approvals than they do talking with the patients they care for.

“Another problem that physicians face in communication is that most of them were never trained in the art of ‘bedside manner.’ The modern physician is trained first and foremost to be a scientist and less a caring listener. As a scientist the modern physician tends to focus on ‘curing diseases’ rather than ‘healing persons.’ Often the scientist/physician is inhibited in communicating with the patient because he or she doesn't know what to do with the natural fears and anxieties that go with illness. For some doctors, the emotional pain of patients is more frightening to deal with than the physical pain. This is true especially when the doctor is the bearer of bad news. It can be very challenging to tell the patient and family that your treatments are not working or that death is on the horizon.

“For many doctors, delivering bad news such as this is like admitting failure. Physicians are a success-oriented breed and to say that you have failed to cure a disease is damaging to your professional and personal self-esteem. However, more and more medical schools are beginning to recognize that the art of caring for real human beings extends beyond scientific competence. Many training facilities are now incorporating educational features to help future physicians learn how to communicate and care for others in a broader, humanitarian way.

“Nevertheless, the burden for clear, timely, and effective communication between the doctor and patient ultimately rests with the physician. The physician, in spite of the many barriers that exist, must assume responsibility to make sure that the patients and families have all the information they need to make good decisions about their health care. From a legal and ethical perspective, we call this the process of “informed consent.” The physician is always obligated to take the necessary time to explain all the risks and benefits of treatment, to discuss alternatives to the recommended treatment, and what the prognosis is likely to be.

“This process calls for ongoing discussions as circumstances change and as new information comes to light. Even if the outcome involves the patient’s ultimate death, the physician should continue to communicate clearly about what can be expected in the dying process and how the patient can receive appropriate care and comfort. How can communication be improved on a practical level? If you are a patient or family member, there are ways in which you can obtain the necessary time and information you need from your physician. If you are in the hospital and have many questions, either write down those questions or get someone close to you to write down all the things you are concerned about. When your doctor comes by on rounds, ask him or her to take a seat and go down your list one by one. Having your doctor sit down will make him or her less likely to leave before you are done. If the doctor insists there is not enough time at the present moment, tell him or her you very much need some additional time and schedule another visit as soon as possible. You have the right to ask for this time, so don't be put off by excuses. The doctor may be legitimately busy, but you or your loved one’s health is the primary concern.

“If you find you are not able to make headway on your own, look for those who can be an advocate for you in the system. Most health care institutions have resource persons such as social workers, patient advocates, chaplains, nurses, and others who are willing to take the time to work on your behalf and help you clarify any concerns. Ask to speak to one of these persons. They often can help with the communication process.

“Another way to improve communication is to request a patient and/or family conference with the physician and other members of the health care team. A conference involving all those who care for the patient can provide a helpful review of the treatment, where things stand today, and what can be expected in the future. In occasions of complicated and life-threatening illness, these conferences can help everyone to ‘get on the same page’ when communication has become confused and information is lacking.

“The most important thing to remember about communicating with your doctor is that you have the right to all the information that is available about your situation. Take the initiative, ask for what you need, get help from someone who can be an advocate on your behalf, and don't be satisfied until you have a clear picture of what is going on. Also, know that there are times when even the best physician can't be sure about what the future holds regarding your illness. But he should be able to say so, honestly and with sensitivity.”

© Copyright FamilyCare America, Inc. All Rights Reserved.

You may want to see:

How To Talk To Your Doctor

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