In the ever-evolving realm of health care in the United States, advancements in patient education have illuminated the need to change the structure of doctor-patient interactions. Research conducted by Michael Barton Laws, assistant professor of health services, policy and practice, Ira Wilson, professor of health services, policy and practice and others revealed that nearly 49 percent of patients fail to recall recommendations and treatments given by their doctors due to a lack of patient participation during visits and ineffective written communications presented to the patient afterwards.
In a pilot project funded by the Patient-Centered Outcomes Research Institute, the team recorded meetings between physicians and patients and later asked them to recall the interaction, Laws said. Although some patients could recall a good portion of the visit once prompted, the majority could remember only one to two thirds of the doctor’s recommendations from the same visit, he added.
Renee Shield, clinical professor of health services, policy and practice who is unaffiliated with the study, feels that this research has even more salient results for the elderly. Shield, whose work examines health care for the elderly and general health practices, believes that the PCORI study shows that “the provision of health care is increasingly complex, … especially for older patients,” she added.
“Any patient might have factors that prevent or inhibit their understanding of what the doctors tell them,” Shield said. The conversational gap between patient and physician has led to a disconnect and necessitates this type of research, she added. “It’s a truism at this point that much of what happens in the doctor-patient interaction does not get either understood by the patient or recalled by the patient.”
The study identified two major issues in doctor-patient communication. First, consultations were usually disorganized — doctors have many visits to get through and delegated only about 15 minutes per patient, leaving visits at times rushed and scattered, Laws said.
Further, the researchers saw a lack of shared decision-making in the consultation process. Wilson said doctors do not spend enough time listening to patients; if they did, doctors would make more informed decisions.
“The problem is it’s very difficult to get doctors to change their behavior,” Laws said.
The researchers suggested the use of an agenda and a checklist of important topics for the visit to ensure that all items are discussed. Additionally, encouraging open questions throughout the consultation and finishing with a wrap-up between physician and patient could promote a more organized and thorough dialogue. The teach-back method — which encourages questions and dialogue between patient and physician — is vital to conversation and understanding, Wilson said.
“People can’t be said to have shared in the decisions about their medical treatment if they don’t know and understand what happened in the visit,” Laws said.
Improvement in patient-to-physician dialogue to increase shared decision-making is critical to patient education, the co-authors said. “It’s probably the most important thing that happens in medicine: doctors and patients talking with each other,” Laws concluded.
