The notion that physicians can “get by” with sub-optimal patient communication skills (for whatever reason) is wrong…
I was talking with my sister recently about physician-patient communication. She is administrative lead in charge of the hospitalist physicians where she works – a large hospital in the Midwest. Not surprisingly, given her responsibility and her loyalty to her docs, she often comes across as an “apologist” when it comes to doctors and their patient communication abilities. Doctors after all are busy. They barely have time to talk to patients while rounding. To expect them to be good communicators is just asking too much.
Making excuses for poor physician-patient communication
This attitude isn’t limited to hospitalists or their managers. Practice administrators and physician office staff are just as likely to make excuses for why their docs shouldn’t be held up to too high a standard when it comes to their patient communication skills. Office staff in primary care settings, e.g., Medical Assistants and Nurses, are being asked to take on more responsibility for communicating with patients. It’s all part of a move to get office staff to “practice up to what their license” will allow.
But implicit in the physician apologist’s mindset is the belief that the ends justify the means. In other words, the fact that physicians are busy justifies in the apologist’s mindset that cutting corners is OK for physicians when it comes to something as seemingly unimportant as “talking with patients.”
This notion that your physicians can “get by” with sub-optimal patient communication skills (for whatever reason) is wrong – both for patients and the rest of the organization. Effective patient communication skills are as essential to the practice of high quality medicine as a physician’s clinical expertise. Good patient communications skills are not optional. Nor can the physician’s responsibility for communicating with patients simply be delegated away.
Why Physician-Patient Communication Is So Important
The accuracy Of the physician’s diagnosis and treatment is completely dependent upon their ability to “get the patient to open up and tell them what’s wrong.” As Sir William Osler, the founder of modern medicine once said, if you listen to the patient they will tell you what the problems is.
Osler’s teaching underscores the importance of the physician’s ability to talk and listen to the patient’s story. The same can be said for the sharing of information, the asking of questions, expressing empathy and support and shared decision making throughout the medical interview.
How can anyone – physician or administrator – think for a moment that it’s OK for physicians, not matter how busy they are, to just “get by” with anything but great patient communication skills? Even worse, how can apologist managers think for a second that such “patient communications” functions as the diagnosis or treatment can be delegated away to a nurse or MA?
The shared mind between doctor and patient
Patient adherence is directly dependent upon the degree to which patients agree or disagree with the physician’s diagnosis and treatment…also called shared mind. If patients don’t agree with the necessity for treatment due to a disagreement with the doctor’s diagnosis…or if the patient does not believe the recommended treatment is safe or effective… patient adherence will not occur.
Arriving at a “shared mind” between physician and patient, therefore, is not optional for physicians…building consensus cannot be delegated to a nurse or MA. A shared mind is between physician and patient is essential to the successful treatment and the patient’s long term adherence.
Trust between the patient and their physician is essential
Patients need to trust their clinician. While a PA or NP may one day earn the same level of patient trust that a physician commands, that’s not usually the case for hospitalists whom the patient meets for the first time upon being hospitalized. Trust according to the research is a function not only of one’s credentials but also their personal attributes, particularly the clinician’s bedside manner, e.g., their ability to communicate and relate to patients. Earning the patient’s trust, even via albeit brief conversations before an emergency procedure, is not optional for physicians.
The take away
The strange thing is that many of the doctors I talk to acknowledge a need to work on their patient communication skills. They just don’t want to have to go back to medical school or spend a week in class away from their busy practice to have to do it.
As such, physicians I believe don’t need nor want apologists to shelter them from what apologists perceive to be unwarranted demands on the physician’s time. Instead of helping their docs, I wonder if physician apologists may actually end up hurting their docs, their patients and their organizations by keeping performance expectations low and foregoing opportunities for much needed physician training and improvement.
So the next time you are asked about whether your physicians might benefit for a new initiative…try and avoid the knee jerk reaction to say “my docs are too busy.” Rather, give serious consideration to the need for what is being proposed…both from the patient’s perspective as well as the clinician’s perspective.
That’s my opinion….what’s yours?
First posted on Mind the Gap Academy 7/16/2014