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You’re Not as Good as You Think (at Communicating)

The quality of doctor-patient communications varies, says Susmita Pati, M.D. “In general, many people feel that many physicians don't communicate very well. On the other hand, there are plenty of folks who feel they have done really great.”

Having a lot of clinical knowledge in rheumatology is good. But a boatload of knowledge may not mean much if you aren’t getting it across to the patient so that he or she understands. 

Good communication between physician and patient is highly correlated with better patient adherence to medication and treatment plans, according to Kelly B. Haskard Zolnierek and M. Robin DiMatteo of Texas State University who, in 2009, published a meta-analysis in the journal Medical Care of 109 studies on patient-doctor communications. The study, which included 21 patient interventions, found that patients are 2.16 times more likely to adhere to treatment regimens when the healthcare team communicates clearly with patients.

"Training in communication is an essential and effective component of medical education and may be even more important in residency training for physicians," they wrote. "Interventions should be broad-based focusing on verbal and nonverbal communication, affective/psychosocial and instrumental/task-oriented behavior, and include the creation of opportunities for active patient involvement."

Barriers to good communication can be subtle. A 2011 study of patients with musculoskeletal disorders published in the journal Health Communication, found that physicians were telling patients they had to adjust to their condition, using phrases like “the new normal.” However, patients talked about pain relief and used phrases like “getting back to normal.” The study, by  Susan C. Baker of the University of Queensland, Australia, concluded that each party was missing the unexpressed differences that they were putting on treatment priorities and not understanding that were working at cross purposes.

In addition to good verbal communication, nonverbal (body language and facial expression) and paraverbal (the tone of voice and the way words are said) communication are as important as what is said.

The Alan Alda Center for Communicating Science

The quality of doctor-patient communications varies, says Susmita Pati, M.D. “In general, many people feel that many physicians don't communicate very well. On the other hand, there are plenty of folks who feel they have done really great.” Although there are stereotypes about how well physicians in different specialties communicate, it is an individual thing, she adds. 

Dr. Pati is chief medical program advisor at the Alan Alda Center for Communicating Science at Stony Brook University and division chief of Primary Care Pediatrics at the Renaissance School of Medicine at Stony Brook University. The center was founded in 2009 by actor Alan Alda to train scientists and health care professionals to “communicate complex topics in clear, vivid and engaging ways.”

Most people think they are better at communicating then they actually are, Dr. Pati says. “And I don't think doctors are any exception.” In medicine, one issue is that communication between physicians and patients is not valued as part of medical care. “The reality of the healthcare environment is such that most physicians have 10 or 15 minutes with every patient that they see. That's what insurance pays for. Nobody's paying for you to sit and answer every single question or go through that side effect list in great detail. Nobody's paying for you to make a phone call after hours, or even during office hours, and ask that question.”

Conveying information to a patient about their medications, especially in a field like rheumatology, can be difficult. “If you look at the side effects on the package insert, it's a ton of information.

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Nobody can communicate all of that in one sitting. and no patient is going to be able to hear or digest all of that. It's really a matter of understanding what the patient is able to understand and wants to know about and responding to those questions.”

Communication skills are taught in medical school, often with standardized patients played by actors, “but those are ideal situations and not real life,” she says. Skills need to be practiced and, perhaps, brushed up on occasionally. “It's really about experience and practice. And really it is all about active listening,” Dr. Pati says. “The core of communication is to really feel that you are listening and actively being present, which takes practice just like practicing an instrument or a sport.”

Many health websites for patients strongly recommend that they bring in another person to an important appointment with a doctor or bring a notebook or voice recorder. “The onus is on the patient to think about what they need,” she says. “Doctors can certainly suggest that, and many of them, when they are giving a serious diagnosis that has life threatening implications or diagnoses that are chronic, absolutely will encourage the families to come.”

“At the Alda Center, we offer workshops in communicating to the healthcare team and with patients. it's really the goal of the workshops to help everyone communicate more clearly more vividly and more effectively,” Dr. Pati says. The center’s workshops use small groups with facilitators and practice communicating. “There is a lot of partner and individual work, and reflection.”

For more information about the Alda Center and its workshops on medical communication, click here.